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NPI Code Detail

MEDICARE: DANIEL A PACELLA DO

MEDICARE: DANIEL A PACELLA DO
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
1208600000XSurgery Physician036066758IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2020006885OTHERILRAILROAD MEDICARE
3F400409513OTHERILMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40031602369OTHERILBLUE CROSS

General Provider Information

NPI Number : 1760488316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL A PACELLA DO
Provider Business Mailing Address
First Line : 16522 106TH CT
Second Line :
City : ORLAND PARK
State : IL
Zip : 60467-4547
Country : US
Telephone Number : 708-361-2266
Fax Number : 708-361-3200
Provider Business Practice Location Address
First Line : 16522 106TH CT
Second Line :
City : ORLAND PARK
State : IL
Zip : 60467-4547
Country : US
Telephone Number : 708-361-2266
Fax Number : 708-361-3200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 08/20/2019

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