Provider Demographics
NPI:1275617862
Name:COLTRO, ADELE (MD07)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:
Last Name:COLTRO
Suffix:
Gender:F
Credentials:MD07
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2607
Mailing Address - Country:US
Mailing Address - Phone:708-768-1127
Mailing Address - Fax:
Practice Address - Street 1:7120 W 131ST ST
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2607
Practice Address - Country:US
Practice Address - Phone:708-768-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine