1851411383 NPI number — MRS. JULIE ANN HAUGEN COTAL

Table of content: MRS. JULIE ANN HAUGEN COTAL (NPI 1851411383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851411383 NPI number — MRS. JULIE ANN HAUGEN COTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAUGEN
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTAL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851411383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 N MARSHFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-6315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-226-2364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 S RIVERSIDE PLZ
Provider Second Line Business Practice Location Address:
SUITE 830
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60606-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-386-0773
Provider Business Practice Location Address Fax Number:
312-627-2700
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  057.001708 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)