Provider Demographics
NPI:1902843733
Name:KOTO, VERNON (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:KOTO
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:701 E. ORANGE ST.
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1801
Practice Address - Country:US
Practice Address - Phone:217-283-5531
Practice Address - Fax:217-283-7981
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36066112207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL930105285OtherRRMCR
IL0360661121Medicaid
IL01620446OtherBLUE CROSS
IL01620446OtherBLUE CROSS
IL0360661121Medicaid