Provider Demographics
NPI:1376721415
Name:DANIEL A PACELLA DO PC
Entity Type:Organization
Organization Name:DANIEL A PACELLA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-227-7751
Mailing Address - Street 1:4N048 NORTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8564
Mailing Address - Country:US
Mailing Address - Phone:708-227-7751
Mailing Address - Fax:
Practice Address - Street 1:16522 106TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4547
Practice Address - Country:US
Practice Address - Phone:708-361-2266
Practice Address - Fax:708-361-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361602369208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL769860Medicare PIN