MEDICARE: BARBARA C KOPCHAK

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
1	363LG0600X	Gerontology Nurse Practitioner	209003790	IL
2	363L00000X	Nurse Practitioner	209003790	IL

General Provider Information

NPI Number	:	1235126269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA C KOPCHAK

Provider Business Mailing Address
First Line	:	630 E NORTH AVE
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2127
Country	:	US
Telephone Number	:	630-861-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 E NORTH AVE
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2127
Country	:	US
Telephone Number	:	630-861-6663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/29/2021

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Directions to “ BARBARA C KOPCHAK ” Practice Location

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