Provider Demographics
NPI:1710129556
Name:KOPIN, GAIL ANN (RDH, COM, ND)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:KOPIN
Suffix:
Gender:F
Credentials:RDH, COM, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2357
Mailing Address - Country:US
Mailing Address - Phone:847-955-0800
Mailing Address - Fax:
Practice Address - Street 1:504 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2357
Practice Address - Country:US
Practice Address - Phone:847-955-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0200005872175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath