Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036063111 | IL |
NPI | 1003812934 |
---|---|
Provider Name | Thomas L Cottrell |
First Address | Park Ridge, IL 60068-5558 |
Second Address | Park Ridge, IL 60068-5556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 10/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15838 | (02) | IL |