Provider Demographics
NPI:1881128866
Name:IACOVELLI, VALERIO
Entity type:Individual
Prefix:DR
First Name:VALERIO
Middle Name:
Last Name:IACOVELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIA PIETRO MARCHISIO 55
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:LAZIO
Mailing Address - Zip Code:00173
Mailing Address - Country:IT
Mailing Address - Phone:0039339-846-1654
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ58593390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program