MEDICARE: COTTAGE EMERGENCY PHYSICIANS LLC

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632287	OTHER	IL	ILLINOIS BLUE SHIELD

General Provider Information

NPI Number	:	1790723724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTAGE EMERGENCY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	7531 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3954
Country	:	US
Telephone Number	:	773-947-7500
Fax Number	:	773-947-7760

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS P WEBSTER
Credential	:	D.O.
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/23/2015

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