Provider Demographics
NPI:1487869616
Name:COE, JEFFREY ELLIS (MD PHD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ELLIS
Last Name:COE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22 NORTH MORGAN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:312-733-6622
Mailing Address - Fax:312-733-8606
Practice Address - Street 1:22 NORTH MORGAN
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-733-6622
Practice Address - Fax:312-733-8606
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12640Medicare UPIN