Provider Demographics
NPI:1508560582
Name:KOKORIS, CELIA
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:KOKORIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 S ELLIS AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5035
Mailing Address - Country:US
Mailing Address - Phone:630-995-5502
Mailing Address - Fax:
Practice Address - Street 1:5465 S ELLIS AVE APT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5035
Practice Address - Country:US
Practice Address - Phone:630-995-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program