Provider Demographics
NPI:1861415291
Name:PALACCI, LIANA GAVRILOV (DO)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:GAVRILOV
Last Name:PALACCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N LAKE SHORE DR APT 20A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5232
Mailing Address - Country:US
Mailing Address - Phone:312-404-7227
Mailing Address - Fax:
Practice Address - Street 1:1150 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5215
Practice Address - Country:US
Practice Address - Phone:312-404-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine