Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005351 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 2006022045 | MO |
NPI | 1013005867 |
---|---|
Provider Name | Dr. Douglas Pacaccio |
First Address | Sycamore, IL 60178-3122 |
Second Address | Yorkville, IL 60560-1366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016005351 | (05) | IL |