Provider Demographics
NPI:1558665869
Name:ELIZABETH PACOCHA DPM PC
Entity Type:Organization
Organization Name:ELIZABETH PACOCHA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PACOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-398-9999
Mailing Address - Street 1:125 E CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2649
Mailing Address - Country:US
Mailing Address - Phone:847-398-9999
Mailing Address - Fax:847-255-1785
Practice Address - Street 1:125 E CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2649
Practice Address - Country:US
Practice Address - Phone:847-398-9999
Practice Address - Fax:847-255-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005329213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1602207OtherBCBS GRP
IL98144391OtherBCBS INDIVIDUAL
IL6639630001Medicare NSC
IL4769Medicare PIN
ILIL4769001Medicare PIN