Individual
CESAR E COELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
409 W OAK ST, CARBONDALE, IL 62901-1414
(618) 529-4455
(618) 351-1287
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-089777
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036089777
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089777
—
IL
01
—
060054049
RAILROAD
IL
Enumeration date
10/18/2006
Last updated
11/29/2023
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