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NPI Code Detail

MEDICARE: RUSH COPLEY MEDICAL GROUP

MEDICARE: RUSH COPLEY MEDICAL GROUP
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1194836247
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSH COPLEY MEDICAL GROUP
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
Second Line : SUITE A
City : AURORA
State : IL
Zip : 60502-9408
Country : US
Telephone Number : 630-499-0812
Fax Number : 630-499-0823
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MARCEE A BRUMMEL
Credential :
Telephone Number : 630-978-4915
Provider Enumeration Date : 08/31/2006
Last Update Date : 02/21/2018

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