Provider Demographics
NPI:1689601171
Name:COTTS, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:COTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G. WILLIAM
Other - Middle Name:
Other - Last Name:COTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 S FRONTAGE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4903
Mailing Address - Country:US
Mailing Address - Phone:630-789-3422
Mailing Address - Fax:630-789-9093
Practice Address - Street 1:11 SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8601
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:630-789-9093
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036032554207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK40519OtherMEDICARE PIN-LOCALITY 15
ILP06044OtherMEDICARE PIN-LOCALITY 16
IL060029748OtherRRMC-LOCALITY 16
IL1316998578OtherNPI GROUP PRACTICE
ILP00408394OtherRRMC-LOCALITY 15
IL1616378OtherBCBS
IL4111035OtherAETNA
ILK40519OtherMEDICARE PIN-LOCALITY 15