Provider Demographics
NPI:1073534681
Name:KOPPE, SEAN WP (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:WP
Last Name:KOPPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:CLINICAL SCIENCES BUILDING (CSB), MC/716
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-3558
Mailing Address - Fax:312-413-2844
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:CLINICAL SCIENCES BUILDING (CSB), MC/716
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-355-3558
Practice Address - Fax:312-413-2844
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36111498207R00000X
IL036111498207RI0008X, 207RG0100X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology