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NPI Code Detail

MEDICARE: SCOTT J COTLER MD

MEDICARE: SCOTT J COTLER MD
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
1207RI0008XHepatology Physician036086423IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10081647422OTHERILBCBS PROVIDER #

General Provider Information

NPI Number : 1225142730
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT J COTLER MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 855-483-7362
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 855-483-7362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 10/27/2020

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