Individual
MARK T. CAPPELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5145 N CALIFORNIA AVE, CHICAGO, IL 60625-3661
(773) 878-8200
(773) 293-8804
Mailing address
2740 W FOSTER AVE, STE 310, CHICAGO, IL 60625-3547
(773) 784-0442
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209001307
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022240951
BCBS
IL
Enumeration date
03/07/2007
Last updated
01/11/2017
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