Provider Demographics
NPI:1285858365
Name:CAPELLI-SCHELLPFEFFER, MARY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CAPELLI-SCHELLPFEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 56TH ST
Mailing Address - Street 2:#1405
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1970
Mailing Address - Country:US
Mailing Address - Phone:773-960-5802
Mailing Address - Fax:
Practice Address - Street 1:5500 S HOHMAN AVE
Practice Address - Street 2:STE 1D
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1965
Practice Address - Country:US
Practice Address - Phone:219-852-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062956A2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI26933-020OtherSTATE OF WISCONSIN
IN01062956AOtherINDIANA PROFESSIONAL
MDD0061063OtherSTATE OF MARYLAND
IL336-042978OtherSTATE OF ILLINOIS