Provider Demographics
NPI:1467450999
Name:COTELL, GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:COTELL
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 1:6131 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2953
Mailing Address - Country:US
Mailing Address - Phone:847-967-5010
Mailing Address - Fax:847-967-5147
Practice Address - Street 1:6131 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2953
Practice Address - Country:US
Practice Address - Phone:847-967-5010
Practice Address - Fax:847-967-5147
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036039771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632926OtherBLUE CROSS BLUE SHIELD
IL01632926OtherBLUE CROSS BLUE SHIELD
ILL93602Medicare ID - Type Unspecified