Provider Demographics
NPI:1255502464
Name:EMELITA C. CO , M.D. S.C.
Entity Type:Organization
Organization Name:EMELITA C. CO , M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMELITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-660-6030
Mailing Address - Street 1:610 S MAPLE AVE STE 3300
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2803
Mailing Address - Country:US
Mailing Address - Phone:708-660-6030
Mailing Address - Fax:708-660-6040
Practice Address - Street 1:610 S MAPLE AVE STE 3300
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2803
Practice Address - Country:US
Practice Address - Phone:708-660-6030
Practice Address - Fax:708-660-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634479OtherBCBS
ILF29648Medicare UPIN
IL1634479OtherBCBS