MEDICARE: DR. THOMAS PATRICK COGAN 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	103T00000X	Psychologist	0712160	IL

General Provider Information

NPI Number	:	1720100928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK COGAN PHD

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1114
City	:	CHICAGO
State	:	IL
Zip	:	60602-3742
Country	:	US
Telephone Number	:	312-782-3092
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1114
City	:	CHICAGO
State	:	IL
Zip	:	60602-3742
Country	:	US
Telephone Number	:	312-782-3092
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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