Provider Demographics
NPI:1598159709
Name:COCKERILL, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:COCKERILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N RAVENSWOOD AVE
Mailing Address - Street 2:STE 255
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:708-475-0788
Mailing Address - Fax:888-312-9495
Practice Address - Street 1:3838 N RAVENSWOOD AVE
Practice Address - Street 2:STE 255
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:708-475-0788
Practice Address - Fax:888-312-9495
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1448002084P0800X
IL0361523222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry