PETRONILO R COSTA (NPI# 1043435340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043435340 |
| Entity Type | Individual |
| Full Name | PETRONILO R COSTA |
| Credential | MD |
| Practice Address |
420 Lake Cook Rd Ste 118 Deerfield IL 60015-4914 |
| Practice Telephone | 8472050237 |
| Practice Fax Number | 8667353898 |
| Mailing Telephone | 8472050237 |
| Mailing Fax Number | 8667353898 |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2016-10-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 036-046-108 | IL | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
036-046-108 | IL | Allopathic & Osteopathic Physicians |
| N | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
036-046-108 | IL | Allopathic & Osteopathic Physicians |
| N | 2080P0008X |
Pediatrics Specialization: Neurodevelopmental Disabilities |
036-046-108 | IL | Allopathic & Osteopathic Physicians |
| Y | 2083P0011X |
Preventive Medicine Specialization: Undersea and Hyperbaric Medicine |
036-046-108 | IL | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
036-046-10 | IL | Allopathic & Osteopathic Physicians |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
036-046-108 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
420 LAKE COOK RD STE 118 |
| City | DEERFIELD |
| State | IL |
| Zip Code | 60015-4914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467073569 | Steven A Ditgen | Physical Therapist | 43 N. Waukegan Road, Deerfield, IL 60015 | 2020-04-29 |
| 1760017255 | Amanda Barkley | Pharmacist | 200 Wilmont Rd, Deerfield, IL 60015 | 2020-03-05 |
| 1467001487 | Nora Fahmi | Pharmacist | Walgreen Co., 200 Wilmot Road, Deerfield, IL 60015 | 2019-09-11 |
| 1477105187 | Anthony Greis | Obstetrics & Gynecology | 540 Lake Cook Road, Suite 300, Deerfield, IL 60015 | 2019-07-12 |
| 1528628484 | Cynthia Lynne Mckinzie | Psychologist | The Neuroscience Center, 440 Lake Cook Road, Deerfield, IL 60015 | 2019-06-13 |
| 1073084497 | Mary Jeane Jeane Velez | Nurse Practitioner | Brentwood Rehabilitation Center, 3705 Deerfield Rd., Deerfield, IL 60015 | 2018-12-11 |
| 1891264644 | Smile On of North Shore, PC | Dentist | 707 Lake Cook Rd., Suite 121, Deerfield, IL 60015 | 2018-11-21 |
| 1497236376 | Linda Li | Counselor | 15 Parkway North Blvd, Deerfield, IL 60015 | 2018-08-28 |
| 1174009831 | Rachael Michelle Lynn | Physician Assistant | 1302 Hazel Ave, Deerfield, IL 60015 | 2018-07-16 |
| 1730675182 | Alexandra Lee Joseph | Social Worker | 420 Lake Cook Road, Suite 113, Deerfield, IL 60015 | 2018-07-09 |
| Find all providers in zip 60015 | ||||
| Taxonomy Code | 2083P0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Undersea and Hyperbaric Medicine |
| A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide poisoning, gas gangrene, non-healing wounds, tissue damage from radiation and burns and bone infections. This specialist also serves as consultant to other physicians in all aspects of hyperbaric chamber operations and assesses risks and applies appropriate standards to prevent disease and disability in divers and other persons working in altered atmospheric conditions. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881065738 | Midwest Institute of Neurological Discovery, LLC | Preventive Medicine | 440 Lake Cook Rd, Deerfield, IL 60015-5242 | 2015-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073995684 | Motaz R Wraikat | Preventive Medicine | 315 S 13th St Ste 3, Herrin, IL 62948 | 2015-06-19 |
| 1669656054 | Jesse Robert Geibe | Preventive Medicine | 2410 Sampson St. (fisher Health Clinic/nhc-503), Naval Health Clinic Great Lakes, Great Lakes, IL 60088-2942 | 2007-12-21 |
| 1164838371 | Sahitya Settypalli | Preventive Medicine | 2 S Hospital Dr, Murphysboro, IL 62966-3333 | 2014-07-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.