Provider Demographics
NPI:1184005670
Name:COCKRUM, RICHARD HAMMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HAMMOND
Last Name:COCKRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:773-702-1061
Mailing Address - Fax:773-702-0840
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 2050
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-0598
Practice Address - Fax:773-702-0840
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144680OtherPHYSICIAN LICENSE NUMBER