Provider Demographics
NPI:1346240082
Name:CAPPELLO, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CAPPELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(MAGUIRE CENTER, RM. 1700)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-3280
Mailing Address - Fax:708-216-5858
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(MAGUIRE CENTER, RM. 1700)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-3280
Practice Address - Fax:708-216-5858
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46684207X00000X
IL036122711207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN961437100Medicaid
MN961437100Medicaid
200002227Medicare ID - Type Unspecified