DR. THADDEUS MANCZKO


Address: 350 N Wall St, Kankakee, IL 60901-2901
Phone: 8159331671

DR. THADDEUS MANCZKO (NPI# 1073553004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073553004
Entity Type Individual
Full Name DR. THADDEUS MANCZKO
Credential M.D.
Practice Address 350 N Wall St
Kankakee
IL 60901-2901
Mailing Address 2000 Green Rd
Suite 300
Ann Arbor
MI 48105-1598
Practice Telephone 8159331671
Mailing Telephone 7349953764
Enumeration Date 2006-06-07
Last Update Date 2008-06-03
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207PE0004X Emergency Medicine
Specialization: Emergency Medical Services
036-100560 IL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL 036100560-7 05

Office Location

Street Address 350 N WALL ST
City KANKAKEE
State IL
Zip Code 60901-2901

Providers in the same location

NPI Name Taxonomy Address Enumeration
1710967955 Yasser A Alhaj-hussein Anesthesiology 350 N Wall St, Dept of Anesthesesia, Kankakee, IL 60901-2901 2006-01-21
1932727229 Elizabeth Ann Christian Speech-Language Pathologist 350 N Wall St, Kankakee, IL 60901-2901 2020-07-13
1649897471 Taryn Mackenzie Linke Speech-Language Pathologist 350 N Wall St, Kankakee, IL 60901-2901 2020-06-27
1629693726 Stephen Tulley Internal Medicine 350 N Wall St, Kankakee, IL 60901-2991 2020-06-15
1891310991 Matthew Sutherland Internal Medicine 350 N Wall St, Kankakee, IL 60901-2991 2020-06-15
1962026302 Kelsie Joann Jamilia Winger Psychiatry & Neurology 350 N Wall St, Kankakee, IL 60901-2991 2020-06-01
1346863321 Ahmed Ismail Internal Medicine 350 N Wall St, Kankakee, IL 60901-2901 2020-05-25
1013539683 Megan L Lucas Pharmacist 350 N Wall St, Kankakee, IL 60901-2991 2020-05-17
1568084523 Alketa Zyka Internal Medicine 350 N Wall St, Kankakee, IL 60901-2901 2020-05-13
1134741028 Shahzaib Khan Psychiatry & Neurology 350 N Wall St, Kankakee, IL 60901-2901 2020-05-13
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1558978841 William Mitsos Dds Dentist 1291 S. 7th Ave, Kankakee, IL 60901 2020-09-30
1922653682 Jody Mcguyer, Lcpc, Cadc Counseling Services, LLC Counselor 315 W. Court St., Kankakee, IL 60901 2019-08-08
1700346327 Sarah Elizabeth Toma Speech-Language Pathologist 200 E Court St #708, Kankakee, IL 60901 2019-03-20
1710473160 Small Talk Speech Services, LLC Clinic/Center 1439 W Vanmeter St, Kankakee, IL 60901 2018-07-09
1124538004 Amy J Green Physical Therapist 350 N. Wall Street, Kankakee, IL 60901 2017-10-05
1013457514 Elizabeth Ann Smith Registered Nurse 292 Charlton Lane, Kankakee, IL 60901 2017-03-02
1861931461 Stacey E. Brown Nurse Practitioner 207 N. Schuyler Ave., Kankakee, IL 60901 2017-02-15
1417352105 Provider Healthcare Services, Inc Home Health 555 South Schuyler, Suite 275, Kankakee, IL 60901 2014-10-24
1265850655 Ronald George Testa Dentist 202 N. Schuyler Ave, Kankakee, IL 60901 2014-04-02
1245587898 Mary Beth Wertz Registered Nurse 100 N Jeffery Street, Kankakee, IL 60901 2012-08-13
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Taxonomy Information

Taxonomy Code 207PE0004X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine
Specialization Emergency Medical Services

Taxonomy Definition

An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1033760715 Michael James Doolin Emergency Medicine 1338 S Clinton St, Chicago, IL 60607-5037 2019-09-24
1578091971 The Board of Trustee for The University of Illinois Emergency Medicine 10000 West O'hare, Terminal 2, Chicago, IL 60660-0508 2017-05-30
1669712808 Kathryn Theresa Pajak Emergency Medicine 5659 S Oak Park Ave, Chicago, IL 60638-3227 2013-02-26
1174832976 Craig William Dean Emergency Medicine 155 N Harbor Dr Apt 309, Chicago, IL 60601-7386 2010-09-28
1770809881 King, Ltd Emergency Medicine 9332 S Vanderpoel Ave, Chicago, IL 60643-5852 2010-04-14
1306098231 Robert Dietz Tetik Emergency Medicine 2272 95th St Ste 106, Naperville, IL 60564-8942 2008-10-22
1831384643 Primus Trauma Care LLC Emergency Medicine 1304 Franklin Avenue, Normal, IL 61761 2007-09-14
1245355411 Pekin Memorial Hospital Emergency Medicine 600 So 13th Street, Pekin, IL 61554-4969 2007-03-20
1396879268 Nanci A Cherry Emergency Medicine 7419 Bell Harbour Dr, Rockford, IL 61114-6600 2007-03-15
1972609782 Jennifer Lynn Webb Emergency Medicine 15730 Robert Louis Dr, Plainfield, IL 60544-2146 2006-09-16
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Competitor

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City KANKAKEE
Zip Code 60901

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Dataset Information

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.

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