Individual
IVAN PACOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, (1950 S. HARLEM AVE., NORTH RIVERSIDE, IL. 60546), MAYWOOD, IL 60153
(708) 354-9250
(708) 354-8765
Mailing address
2160 S 1ST AVE, (1950 S. HARLEM AVE., NORTH RIVERSIDE, IL. 60546), MAYWOOD, IL 60153
(708) 354-9250
(708) 354-8765
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36059612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36059612
—
IL
Enumeration date
01/17/2006
Last updated
03/04/2010
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