Healthcare Provider Details

I. General information

NPI: 1942263090
Provider Name (Legal Business Name): JUDITH A COTHRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 OLD ORCHARD CENTER SUITE 200
SKOKIE IL
60077-1462
US

IV. Provider business mailing address

4905 OLD ORCHARD CENTER SUITE 200
SKOKIE IL
60077-1462
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-3130
  • Fax: 312-695-3169
Mailing address:
  • Phone: 847-673-3130
  • Fax: 312-695-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036091412
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-091412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: