Provider Demographics
NPI:1942263090
Name:COTHRAN, JUDITH A (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 OLD ORCHARD CENTER
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1462
Mailing Address - Country:US
Mailing Address - Phone:847-673-3130
Mailing Address - Fax:312-695-3169
Practice Address - Street 1:4905 OLD ORCHARD CENTER
Practice Address - Street 2:SUITE 200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1462
Practice Address - Country:US
Practice Address - Phone:847-673-3130
Practice Address - Fax:312-695-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091412207V00000X
IL036.091412207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG15264Medicare UPIN
G15264Medicare UPIN