Provider Demographics
NPI:1093704439
Name:CACCOPOLA, JEANENE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANENE
Middle Name:MARIE
Last Name:CACCOPOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1833
Mailing Address - Country:US
Mailing Address - Phone:847-868-0484
Mailing Address - Fax:847-305-1456
Practice Address - Street 1:550 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1833
Practice Address - Country:US
Practice Address - Phone:847-868-0484
Practice Address - Fax:847-305-1456
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036109750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine