Provider Demographics
NPI:1831104645
Name:LOCOCO, SALVATORE J (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:J
Last Name:LOCOCO
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 1:1 ILLINI DR
Mailing Address - Street 2:BOX 1649
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2576
Mailing Address - Country:US
Mailing Address - Phone:309-655-3024
Mailing Address - Fax:309-655-3739
Practice Address - Street 1:1 ILLINI DR
Practice Address - Street 2:BOX 1649
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2576
Practice Address - Country:US
Practice Address - Phone:309-655-3024
Practice Address - Fax:309-655-3739
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5786207VX0201X
IL036123856207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5593OtherBCBS
TX139534502Medicaid
TXP00261072OtherRAILROAD MEDICARE
TXP00261072OtherRAILROAD MEDICARE
TX8D9048Medicare PIN