Provider Demographics
NPI:1548207855
Name:KRAFF COOPER, CHERYL B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:B
Last Name:KRAFF COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:STE 606
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1731
Mailing Address - Country:US
Mailing Address - Phone:773-777-4444
Mailing Address - Fax:312-736-7873
Practice Address - Street 1:3115 N HARLEM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4684
Practice Address - Country:US
Practice Address - Phone:773-777-4444
Practice Address - Fax:312-736-7873
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068475207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012409OtherRAILROAD MEDICARE
IL036068475Medicaid
IL180012409OtherRAILROAD MEDICARE
ILC49385Medicare UPIN
IL036068475Medicaid