Provider Demographics
NPI:1003936618
Name:COVELLO, ANTONIO LEE JR (SA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:LEE
Last Name:COVELLO
Suffix:JR
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21200 S LAGRANGE RD STE 322
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2003
Mailing Address - Country:US
Mailing Address - Phone:720-837-7992
Mailing Address - Fax:303-955-6464
Practice Address - Street 1:5183 S COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4023
Practice Address - Country:US
Practice Address - Phone:720-837-7992
Practice Address - Fax:303-955-6464
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No171W00000XOther Service ProvidersContractor