Provider Demographics
NPI:1760488316
Name:PACELLA, DANIEL A (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:PACELLA
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 1:16522 106TH CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4547
Mailing Address - Country:US
Mailing Address - Phone:708-361-2266
Mailing Address - Fax:708-361-3200
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066758208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066758Medicaid
IL020006885OtherRAILROAD MEDICARE
ILF400409513OtherMEDICARE PTAN
IL0031602369OtherBLUE CROSS
IL0031602369OtherBLUE CROSS
ILC48952Medicare UPIN