Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 036089777 | IL |
NPI | 1003997560 |
---|---|
Provider Name | Cesar E Coello |
First Address | Carbondale, IL 62902-3988 |
Second Address | Carbondale, IL 62901-1414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089777 | (05) | IL |
060054049 | RAILROAD (01) | IL |
F93027 | (02) | IL |