Doctor Name: | DR. DOUGLAS PACACCIO |
NPI Number: | 1013005867 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 2006022045 |
Business Practice Address: | 215 Hillcrest Ave Suite B Yorkville, IL - 605601366 |
Business Phone Number: | 6303523700 |
Business Fax Number: | 8159866062 |
Mailing Address: | 2180 Oakland Dr, Unit A SYCAMORE |
State: | IL |
Postal Code: | 601783122 |
Phone Number: | 8156694811 |
Fax Number: | 8159866062 |
NPI Enumeration Date: | 10/10/2006 |
NPI Last Update Date: | 05/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 2006022045 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |