MEDICARE: DR. GREGORY JOSEPH PACELLI M.D., PH.D.

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	207W00000X	Ophthalmology Physician	036103468	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245331388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY JOSEPH PACELLI M.D., PH.D.

Provider Business Mailing Address
First Line	:	1431 N WESTERN AVE
Second Line	:	STE 206
City	:	CHICAGO
State	:	IL
Zip	:	60622-1773
Country	:	US
Telephone Number	:	773-395-1600
Fax Number	:	773-395-2600

Provider Business Practice Location Address
First Line	:	3541 W IRVING PARK RD
Second Line	:	BUILDING 1E
City	:	CHICAGO
State	:	IL
Zip	:	60618-3219
Country	:	US
Telephone Number	:	773-478-1600
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	03/04/2016

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