Provider Demographics
NPI:1962456442
Name:COLTRO, JERRY RENATO (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RENATO
Last Name:COLTRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9830 RIDGELAND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2668
Mailing Address - Country:US
Mailing Address - Phone:708-422-6800
Mailing Address - Fax:708-422-6888
Practice Address - Street 1:9830 RIDGELAND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2667
Practice Address - Country:US
Practice Address - Phone:708-422-6800
Practice Address - Fax:708-422-6888
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-01-11
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Provider Licenses
StateLicense IDTaxonomies
IL036070297207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16620Medicare UPIN