Provider Demographics
NPI:1649325929
Name:CORDERO, NELA RODRIGUEZ (MD)
Entity type:Individual
Prefix:DR
First Name:NELA
Middle Name:RODRIGUEZ
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WELLINGBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6156
Mailing Address - Country:US
Mailing Address - Phone:847-277-1740
Mailing Address - Fax:847-277-1744
Practice Address - Street 1:2002 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4527
Practice Address - Country:US
Practice Address - Phone:773-486-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053399207QA0000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053399Medicaid
IL036053399Medicaid
ILD13201Medicare UPIN