MEDICARE: SHELDON COTLER ET AL PTR NORTH SHORE CONSULTATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1669650578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELDON COTLER ET AL PTR NORTH SHORE CONSULTATION CENTER

Provider Business Mailing Address
First Line	:	1535 LAKE COOK RD
Second Line	:	SUITE #111
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1450
Country	:	US
Telephone Number	:	847-498-4744
Fax Number	:	847-498-4811

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD
Second Line	:	SUITE #111
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1450
Country	:	US
Telephone Number	:	847-498-4744
Fax Number	:	847-498-4811

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ROBERT L DAVENPORT
Credential	:	PHD
Telephone Number	:	847-498-4744

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	06/23/2008

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