1760587869 NPI number — GREGG S COCCARO M.D.

Table of content: GREGG S COCCARO M.D. (NPI 1760587869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760587869 NPI number — GREGG S COCCARO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCCARO
Provider First Name:
GREGG
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760587869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1423 CHICAGO RD
Provider Second Line Business Mailing Address:
RADIOLOGY DEPARTMENT
Provider Business Mailing Address City Name:
CHICAGO HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60411-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-756-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 CHICAGO RD
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
CHICAGO HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-756-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  036085552 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 131719100 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036085552 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: L022428 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300050047 . This is a "RAILROAD ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 078631 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1618334 . This is a "BCBS ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".