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
1	207R00000X	Internal Medicine Physician	036076800	IL
2	207RG0100X	Gastroenterology Physician	036076800	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477831220
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	:	1256 WATERFORD DR
Second Line	:	SUITE 120
City	:	AURORA
State	:	IL
Zip	:	60504-4510
Country	:	US
Telephone Number	:	630-820-4040
Fax Number	:	630-978-1240

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	02/21/2018

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Directions to “RUSH-COPLEY MEDICAL GROUP ” Practice Location

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