Provider Demographics
NPI:1013005867
Name:PACACCIO, DOUGLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:PACACCIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 OAKLAND DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3122
Mailing Address - Country:US
Mailing Address - Phone:815-669-4811
Mailing Address - Fax:815-986-6062
Practice Address - Street 1:215 HILLCREST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1366
Practice Address - Country:US
Practice Address - Phone:630-352-3700
Practice Address - Fax:815-986-6062
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022045213ES0103X
IL016005351213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005351Medicaid
IL016005351Medicaid
IL1289950001Medicare NSC
ILK48195Medicare PIN