Provider Demographics
NPI:1336359991
Name:JOHN M. COTTRELL D.O. CHARTERED
Entity Type:Organization
Organization Name:JOHN M. COTTRELL D.O. CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-318-5500
Mailing Address - Street 1:2 W TALCOTT RD STE 16
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5558
Mailing Address - Country:US
Mailing Address - Phone:847-318-5500
Mailing Address - Fax:847-318-1567
Practice Address - Street 1:2 W TALCOTT RD STE 16
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5558
Practice Address - Country:US
Practice Address - Phone:847-318-5500
Practice Address - Fax:847-318-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071939208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty