Deavolon Cotton
Individual provider Active NPI Driver · Homewood, IL
NPI 1922407949 · NPPES record last updated Aug 14, 2014
Key facts
- NPI
- 1922407949
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 831 Maple Ave Ste 128
Homewood, IL 60430-2031 - Phone
- (773) 209-8081
- NPI assigned
- Aug 14, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
831 Maple Ave Ste 128
Homewood, IL 60430-2031
Mailing address
831 Maple Ave Ste 128
Homewood, IL 60430-2031
Phone (773) 209-8081
Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.