MEDICARE: MR. JOSEPH IACOPELLI CRNA

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	367500000X	Certified Registered Nurse Anesthetist	041318670	IL

General Provider Information

NPI Number	:	1952327223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH IACOPELLI CRNA

Provider Business Mailing Address
First Line	:	240 E ILLINOIS ST
Second Line	:	UNIT 1011
City	:	CHICAGO
State	:	IL
Zip	:	60611-5063
Country	:	US
Telephone Number	:	773-968-9863
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E ILLINOIS ST APT 1011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5032
Country	:	US
Telephone Number	:	773-968-9863
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/03/2022

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