Individual
SHANTA COPPAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 W MADISON ST, CHICAGO, IL 60606-3414
(312) 277-4090
Mailing address
200 W MADISON ST, CHICAGO, IL 60606-3414
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/24/2020
Last updated
12/24/2020
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