MEDICARE: RUSH-COPLEY MEDICAL GROUP, NFP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician
2	207R00000X	Internal Medicine Physician
3	207RG0100X	Gastroenterology Physician
4	207RH0003X	Hematology & Oncology Physician
5	207RP1001X	Pulmonary Disease Physician
6	207RS0010X	Sports Medicine (Internal Medicine) Physician
7	207T00000X	Neurological Surgery Physician
8	207V00000X	Obstetrics & Gynecology Physician
9	207Y00000X	Otolaryngology Physician
10	208000000X	Pediatrics Physician
11	208200000X	Plastic Surgery Physician	036-079730	IL
12	208600000X	Surgery Physician	036-102434	IL
13	208800000X	Urology Physician
14	261QU0200X	Urgent Care Clinic/Center
15	207Q00000X	Family Medicine Physician

NPI Number	:	1093075848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH-COPLEY MEDICAL GROUP, NFP

Provider Business Mailing Address
First Line	:	1256 WATERFORD DR STE 230
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-4511
Country	:	US
Telephone Number	:	630-499-2404
Fax Number	:	630-692-5518

Provider Business Practice Location Address
First Line	:	2972 INDIAN TRAIL RD STE A
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9408
Country	:	US
Telephone Number	:	630-499-0812
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARCEE A BRUMMEL
Credential	:
Telephone Number	:	630-978-4915

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	08/04/2020