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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
036-100560 | IL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | 036100560-7 | 05 |
Street Address |
350 N WALL ST |
City | KANKAKEE |
State | IL |
Zip Code | 60901-2901 |
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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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 |
Find all providers in zip 60901 |
Taxonomy Code | 207PE0004X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Emergency Medicine |
Specialization | Emergency Medical Services |
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. |
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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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.