Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016.005329 | IL |
NPI | 1023297132 |
---|---|
Provider Name | Dr. Elizabeth Pacocha |
First Address | Carol Stream, IL 60188-4320 |
Second Address | Elk Grove Village, IL 60007-3371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016005329 | (05) | IL |
1194777698 | GROUP NPI (01) | IL |
60001380 | BCBS (01) | IL |
726711 | GROUP MEDICARE # (01) | IL |