Provider Demographics
NPI:1578573705
Name:PICCHIETTI, DANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:PICCHIETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-7117
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:SLEEP MEDICINE
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-3190
Practice Address - Fax:217-383-7117
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360623032084S0012X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270158Medicare PIN
IL6447860011Medicare NSC
ILC43500Medicare UPIN
C43500Medicare UPIN