Provider Demographics
NPI:1801326681
Name:COPPEL, SCOTT H (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:COPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S MICHIGAN AVE APT 1411
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2836
Mailing Address - Country:US
Mailing Address - Phone:614-746-2029
Mailing Address - Fax:
Practice Address - Street 1:5401 S WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-6300
Practice Address - Country:US
Practice Address - Phone:773-288-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11019407A390200000X
IL036.153996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.153996OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION