Provider Demographics
NPI:1548657323
Name:CHARLOTTE M COVELLO DPM LLC
Entity type:Organization
Organization Name:CHARLOTTE M COVELLO DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-748-3338
Mailing Address - Street 1:30 NORTH MICHIGAN AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3809
Mailing Address - Country:US
Mailing Address - Phone:312-701-0770
Mailing Address - Fax:312-701-0705
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2097
Practice Address - Country:US
Practice Address - Phone:708-748-3338
Practice Address - Fax:708-748-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93160Medicare UPIN