Provider Demographics
NPI:1225119928
Name:NORTHERN ILLINOIS PLASTIC SURGERY CONSULTANTS LTD
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS PLASTIC SURGERY CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPOLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-323-2369
Mailing Address - Street 1:950 N YORK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-323-2369
Mailing Address - Fax:630-323-2391
Practice Address - Street 1:2127 MIDLANDS CT
Practice Address - Street 2:102
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3173
Practice Address - Country:US
Practice Address - Phone:815-758-3057
Practice Address - Fax:630-323-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51717Medicare UPIN
952370Medicare ID - Type Unspecified