Provider Demographics
NPI:1871591115
Name:COPLEY, KEVIN ALAN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:COPLEY
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9400
Mailing Address - Country:US
Mailing Address - Phone:847-289-8262
Mailing Address - Fax:847-214-5745
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:STE 360
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-289-8262
Practice Address - Fax:847-214-5745
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084462207V00000X
CODR.0067812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632088OtherBCBS
IL036084462Medicaid
IL05632088OtherBCBS
ILP00897047Medicare PIN
ILK04888Medicare PIN
ILK04889Medicare PIN
ILF65790Medicare UPIN
IL05632088OtherBCBS