Basic Information
| Provider Information | |||||||||
| NPI: | 1457743510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOTTOOR | ||||||||
| FirstName: | SOBHA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JIBY | ||||||||
| OtherFirstName: | SOBHA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 804 E WOODFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476059500 | ||||||||
| FaxNumber: | 8476058700 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 E WOODFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476059500 | ||||||||
| FaxNumber: | 8476058700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 08/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209012520 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.