Provider Demographics
NPI:1003812934
Name:COTTRELL, THOMAS L (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:COTTRELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 W TALCOTT RD
Mailing Address - Street 2:STE 16
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5558
Mailing Address - Country:US
Mailing Address - Phone:847-297-2240
Mailing Address - Fax:847-297-7270
Practice Address - Street 1:2 W TALCOTT RD
Practice Address - Street 2:STE 11
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-318-5500
Practice Address - Fax:847-318-1567
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2017-07-10
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Provider Licenses
StateLicense IDTaxonomies
IL036063111208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15838Medicare UPIN