MEDICARE: THOMAS PATRICK COTHRAN PHD

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	103G00000X	Clinical Neuropsychologist	20043418A	IN
2	103TC0700X	Clinical Psychologist	071.010299	IL
3	103TC0700X	Clinical Psychologist	20043418A	IN
4	103G00000X	Clinical Neuropsychologist	071.010299	IL

General Provider Information

NPI Number	:	1003197856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS PATRICK COTHRAN PHD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:	847-570-5315

Provider Business Practice Location Address
First Line	:	8 SALT CREEK LN STE 202
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-2903
Country	:	US
Telephone Number	:	847-425-6400
Fax Number	:	847-425-6408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	05/22/2025

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