Provider Demographics
NPI:1124609094
Name:COPPEDGE, SABRINA HOPE (MD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:HOPE
Last Name:COPPEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:HC
Other - Last Name:KROGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 W LAKE ST STE 41983
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-0239
Mailing Address - Country:US
Mailing Address - Phone:312-248-9988
Mailing Address - Fax:864-448-1459
Practice Address - Street 1:201 W LAKE ST STE 41983
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-0239
Practice Address - Country:US
Practice Address - Phone:312-248-9988
Practice Address - Fax:864-448-1459
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.1728212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program