Healthcare Provider Details

I. General information

NPI: 1891689139
Provider Name (Legal Business Name): KERRIE LOUISE MCCOTTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

325 E SCRANTON AVE
LAKE BLUFF IL
60044-2533
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-2855
  • Fax: 312-864-9787
Mailing address:
  • Phone: 224-730-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: