Provider Demographics
NPI:1689202608
Name:KOPLOWITZ, JAKE
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:KOPLOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ILLINOIS HOSPITAL, 1740 W. TAYLOR ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:708-684-5674
Mailing Address - Fax:708-684-2500
Practice Address - Street 1:UNIVERSITY OF ILLINOIS HOSPITAL, 1740 W. TAYLOR ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:708-684-5674
Practice Address - Fax:708-684-2500
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program