Provider Demographics
NPI:1457098410
Name:CZOPEK, COREY JAY (PA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:JAY
Last Name:CZOPEK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 CORNELL CT
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1004
Mailing Address - Country:US
Mailing Address - Phone:630-881-3397
Mailing Address - Fax:
Practice Address - Street 1:1527 CORNELL CT
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1004
Practice Address - Country:US
Practice Address - Phone:630-881-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant