Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016.005479 | IL |
NPI | 1023388931 |
---|---|
Provider Name | Dr. Diana M Covelli |
First Address | Chicago, IL 60618-1233 |
Second Address | Chicago, IL 60624-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2012 |
Last Update Date | 09/01/2012 |