DONALD JAMES MADDACK (NPI# 1013911031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013911031 |
| Entity Type | Individual |
| Full Name | DONALD JAMES MADDACK |
| Credential | DO |
| Practice Address |
3125 Willowcreek Rd Portage IN 46368-4423 |
| Mailing Address |
2022 Kelle Dr Chesterton IN 46304-8708 |
| Practice Telephone | 2197623175 |
| Practice Fax Number | 2197633092 |
| Mailing Telephone | 2193643616 |
| Mailing Fax Number | 2193643610 |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2020-09-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 02001180 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | AMTHEM BC/BS | 000000093873 | 01 |
| IN | RAILROAD MEDICARE | 080152595 | 01 |
| IN | 100352910 | 05 |
| Street Address |
3125 WILLOWCREEK RD |
| City | PORTAGE |
| State | IN |
| Zip Code | 46368-4423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205872132 | Amy Lorraine Sobas | Nurse Practitioner | 3125 Willowcreek Rd, Portage, IN 46368-4423 | 2006-06-20 |
| 1881691947 | Leonard Walter Ostrowski Jr. | Family Medicine | 3125 Willowcreek Rd, Portage, IN 46368-4423 | 2005-07-05 |
| 1679578272 | Louis Miceli | Family Medicine | 3125 Willowcreek Rd, Portage, IN 46368-4423 | 2005-06-20 |
| 1427053255 | Kenneth Wayne Blumenthal | Family Medicine | 3125 Willowcreek Rd, Portage, IN 46368-4423 | 2005-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366041121 | Latresa Renee Sims | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1777 Armstrong St. Suite C., Portage, IN 46368 | 2020-10-22 |
| 1831576693 | Bishara Robert Khoury | Family Medicine | 3545 Arbor Blvd Ste E, Portage, IN 46368 | 2015-04-30 |
| 1962813535 | Diane Farrington | Pharmacist | 6050 Us Hwy 6, Portage, IN 46368 | 2014-05-16 |
| 1588827562 | Jennifer Ann Rumpel | Allergy & Immunology | 6375 Us Highway 6 Ste C, Portage, IN 46368 | 2008-07-09 |
| 1588822688 | Total Renal Care Inc | Clinic/Center | 5823 Us Highway 6, Portage, IN 46368 | 2008-05-27 |
| 1235321480 | Michael Wendahl | Physical Therapist | 3691 Willowcreek Road, Suite 100, Portage, IN 46368 | 2007-08-13 |
| 1679663603 | Stephen V Headley | Family Medicine | 3283 Willowcreek Rd, Portage, IN 46368 | 2006-10-13 |
| 1730276486 | Robert Tan Ang | Psychiatry & Neurology | 3156 Willowcreek Road, Portage, IN 46368 | 2006-10-06 |
| 1013029883 | Primary Care PC | Family Medicine | 3125 Willowcreek Road, Portage, IN 46368 | 2006-08-31 |
| 1104936962 | Margaret Eileen Griffith | Dentist | 2646 Lois Street, Portage, IN 46368 | 2006-08-30 |
| Find all providers in zip 46368 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.