Provider Demographics
NPI:1972681286
Name:COVELLO, CHARLOTTE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:M
Last Name:COVELLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2097
Mailing Address - Country:US
Mailing Address - Phone:708-748-3338
Mailing Address - Fax:312-701-0705
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2097
Practice Address - Country:US
Practice Address - Phone:708-748-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93160Medicare UPIN