Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 135.000836 | IL |
Y | 222Z00000X | Podiatrist | 135.000836 | IL |
NPI | 1063820231 |
---|---|
Provider Name | Dr. Thomas John Cockayne JR. |
First Address | North Chicago, IL 60064-3048 |
Second Address | Chicago, IL 60608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 31/07/2014 |