MEDICARE: DR. MAGDALENA ANIA IANNELLO 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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	125.087218	IL
2	208200000X	Plastic Surgery Physician	125.087218	IL

General Provider Information

NPI Number	:	1780423434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGDALENA ANIA IANNELLO MD

Provider Business Mailing Address
First Line	:	PO BOX 19653
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	747 N RUTLEDGE ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-6700
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-2588

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

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	06/02/2026

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