MEDICARE: MARY D CODO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036-082140	IL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036082140	IL
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036-082140	IL

General Provider Information

NPI Number	:	1568504439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY D CODO MD

Provider Business Mailing Address
First Line	:	PO BOX 713260
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1260
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 E OGDEN AVE STE 100
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8610
Country	:	US
Telephone Number	:	630-789-4910
Fax Number	:	630-789-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/04/2023

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Directions to “ MARY D CODO MD” Practice Location

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