Provider Demographics
NPI:1235236241
Name:COPPS, PAUL (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:COPPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OGDEN AVE.
Mailing Address - Street 2:SUITE 313
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7222
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:472 N. RTE. 47
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-466-6000
Practice Address - Fax:630-466-6001
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109034207Q00000X
AK3922207Q00000X
TXJ5734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361-09034Medicaid
IL361-09034Medicaid
E87800Medicare UPIN