Basic Information
| Provider Information | |||||||||
| NPI: | 1629430491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COUGHLIN | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | MARJORY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 W HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129426510 | ||||||||
| FaxNumber: | 3129422867 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 W HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129426510 | ||||||||
| FaxNumber: | 3129422867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 125.069100 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.