Provider Demographics
NPI:1245331388
Name:PACELLI, GREGORY JOSEPH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:PACELLI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1773
Mailing Address - Country:US
Mailing Address - Phone:773-395-1600
Mailing Address - Fax:773-395-2600
Practice Address - Street 1:3541 W IRVING PARK RD
Practice Address - Street 2:BUILDING 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3219
Practice Address - Country:US
Practice Address - Phone:773-478-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103468207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103468Medicaid
IL036103468Medicaid
IL204791Medicare ID - Type UnspecifiedWILL COUNTY
IL203174Medicare ID - Type UnspecifiedCOOK COUNTY