Individual
DR. DOUGLAS JOSEPH PACACCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 398-9491
(815) 381-7498
Mailing address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016005351
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005351
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
2006022045
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005351
—
IL
Enumeration date
10/10/2006
Last updated
09/26/2024
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