Provider Demographics
NPI:1972731172
Name:ROBERSON COOPER, KORTNEE Y (MD)
Entity Type:Individual
Prefix:
First Name:KORTNEE
Middle Name:Y
Last Name:ROBERSON COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KORTNEE
Other - Middle Name:Y
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6835 S CHAPPEL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1606
Mailing Address - Country:US
Mailing Address - Phone:312-631-5100
Mailing Address - Fax:
Practice Address - Street 1:6835 S CHAPPEL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1606
Practice Address - Country:US
Practice Address - Phone:312-631-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine