Basic Information
| Provider Information | |||||||||
| NPI: | 1639296486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COPERNICUS MEDICAL CORPORATION.,LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5251 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606304634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732839300 | ||||||||
| FaxNumber: | 7732830098 | ||||||||
| Practice Location | |||||||||
| Address1: | 5251 N MILWAUKEE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606304634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732839300 | ||||||||
| FaxNumber: | 7732830098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHOJNACKI | ||||||||
| AuthorizedOfficialFirstName: | RAFAL | ||||||||
| AuthorizedOfficialMiddleName: | JACEK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7732839300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.