Provider Demographics
NPI:1376514273
Name:COTE, MARIO E (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:E
Last Name:COTE
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 1:1305 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2759
Mailing Address - Country:US
Mailing Address - Phone:815-223-3500
Mailing Address - Fax:815-223-1790
Practice Address - Street 1:SMH-PERU/PERU MEDICAL CENTER
Practice Address - Street 2:920 WEST ST SUITE 17
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354
Practice Address - Country:US
Practice Address - Phone:815-223-3500
Practice Address - Fax:815-223-1790
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079954Medicaid
05000342Medicare ID - Type Unspecified
IL036079954Medicaid
IL819300022Medicare PIN
IL215379004Medicare PIN