Healthcare Provider Details

I. General information

NPI: 1003936618
Provider Name (Legal Business Name): ANTONIO LEE COVELLO JR. SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5183 S COOLIDGE ST
AURORA CO
80016-4023
US

IV. Provider business mailing address

21200 S LAGRANGE RD STE 322
FRANKFORT IL
60423-2003
US

V. Phone/Fax

Practice location:
  • Phone: 720-837-7992
  • Fax: 303-955-6464
Mailing address:
  • Phone: 720-837-7992
  • Fax: 303-955-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: