Provider Demographics
NPI:1396813069
Name:CO, EMELITA C (MD)
Entity type:Individual
Prefix:DR
First Name:EMELITA
Middle Name:C
Last Name:CO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:137 N OAK PARK AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1300
Mailing Address - Country:US
Mailing Address - Phone:708-327-1380
Mailing Address - Fax:708-386-3071
Practice Address - Street 1:137 N OAK PARK AVE STE 125
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1300
Practice Address - Country:US
Practice Address - Phone:708-327-1380
Practice Address - Fax:708-386-3071
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036083879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF29648Medicare UPIN
IL209454Medicare ID - Type UnspecifiedPROVIDER #