Provider Demographics
NPI:1114987450
Name:CAPPITELLI, DENNIS W (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:CAPPITELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLLEGE AND UNIVERSITY 2540
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-2540
Mailing Address - Country:US
Mailing Address - Phone:309-438-2956
Mailing Address - Fax:309-438-3689
Practice Address - Street 1:COLLEGE AND UNIVERSITY 2540
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-2540
Practice Address - Country:US
Practice Address - Phone:309-438-2956
Practice Address - Fax:309-438-3689
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC5296238OtherDEA