Provider Demographics
NPI:1336185552
Name:PACHUCKI, CONSTANCE THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:THERESA
Last Name:PACHUCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 DIVISION ST STE 607
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5533
Mailing Address - Country:US
Mailing Address - Phone:847-695-1093
Mailing Address - Fax:847-695-0501
Practice Address - Street 1:164 DIVISION ST STE 607
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5533
Practice Address - Country:US
Practice Address - Phone:847-695-1093
Practice Address - Fax:847-695-0501
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057461207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400129895Medicare PIN