Provider Demographics
NPI:1063579472
Name:PAOLUCCI, ADA VERA (DPM)
Entity type:Individual
Prefix:DR
First Name:ADA
Middle Name:VERA
Last Name:PAOLUCCI
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:1960 ESSINGTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1617
Mailing Address - Country:US
Mailing Address - Phone:815-436-3555
Mailing Address - Fax:815-436-3578
Practice Address - Street 1:1960 ESSINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1617
Practice Address - Country:US
Practice Address - Phone:815-436-3555
Practice Address - Fax:815-436-3578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016-004462213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5536200001Medicare NSC
ILU12020Medicare UPIN
IL942340Medicare PIN