Provider Demographics
NPI:1952327223
Name:IACOPELLI, JOSEPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:IACOPELLI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E ILLINOIS ST
Mailing Address - Street 2:UNIT 1011
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5063
Mailing Address - Country:US
Mailing Address - Phone:773-968-9863
Mailing Address - Fax:
Practice Address - Street 1:240 E ILLINOIS ST APT 1011
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5032
Practice Address - Country:US
Practice Address - Phone:773-968-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041318670367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13042Medicare PIN
ILK21430Medicare PIN
ILK21431Medicare PIN
ILK20691Medicare PIN