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Individual
FELIPE COSCOLLUELA JAVIER III
Active
Individual
FELIPE COSCOLLUELA JAVIER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
036-100466
IL
207K00000X
Allergy & Immunology Physician
Primary
32545
IA
208000000X
Pediatrics Physician
036-100466
IL
208000000X
Pediatrics Physician
32545
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203896410
—
MO
01
—
33628
BLUE CROSS BLUE SHIELD
—
01
—
421527584
TRI-CARE GROUP NUMBER
—
05
—
421527584003
—
IL
01
—
42152758408
JOHN DEERE
—
05
—
O278374
—
IA
Enumeration date
05/27/2005
Last updated
03/17/2018
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