Provider Demographics
NPI:1528105723
Name:RUSH-COPLEY MEDICAL GROUP
Entity type:Organization
Organization Name:RUSH-COPLEY MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-499-4749
Mailing Address - Street 1:1100 VETERAN'S PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1366
Mailing Address - Country:US
Mailing Address - Phone:630-466-3470
Mailing Address - Fax:630-375-2905
Practice Address - Street 1:1100 VETERANS PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1366
Practice Address - Country:US
Practice Address - Phone:630-466-3470
Practice Address - Fax:630-375-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-043320207K00000X, 207YX0905X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39019Medicare UPIN