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NPI Code Detail

MEDICARE: MR. ROBERT A LANE COTA/L

MEDICARE: MR. ROBERT A LANE COTA/L
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
1174400000XSpecialist057001193IL

General Provider Information

NPI Number : 1932362167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT A LANE COTA/L
Provider Business Mailing Address
First Line : 1201 NEWCASTLE RD
Second Line :
City : WASHINGTON
State : IL
Zip : 61571-1243
Country : US
Telephone Number : 309-444-1065
Fax Number : 309-444-1095
Provider Business Practice Location Address
First Line : 1201 NEWCASTLE RD
Second Line :
City : WASHINGTON
State : IL
Zip : 61571-1243
Country : US
Telephone Number : 309-444-1065
Fax Number : 309-444-1095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2008
Last Update Date : 07/08/2008

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Directions to “ MR. ROBERT A LANE COTA/L” Practice Location

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