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Individual
DAVID G IACCINO
Active
Individual
DAVID G IACCINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003882
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480006875
RAILROAD MCR
—
01
—
60001580
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/13/2006
Last updated
10/30/2008
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