IL S KWAK MD INC (NPI# 1134318447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1134318447 |
Entity Type | Organization |
Organization Name | IL S KWAK MD INC |
Practice Address |
2222 Timberbrook Trl Fort Wayne IN 46845-9530 |
Mailing Address |
2222 Timberbrook Trl Fort Wayne IN 46845 |
Practice Telephone | 2606373939 |
Practice Fax Number | 2606373939 |
Mailing Telephone | 2606373939 |
Mailing Fax Number | 2606373939 |
Enumeration Date | 2007-10-23 |
Last Update Date | 2010-07-08 |
Authorized Official Name | DR. IL S KWAK (PRESIDENT) |
Authorized Official Telephone | 2606373939 |
Authorized Official Credential | M.D |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 174400000X | Specialist | 01026132A | IN | Other Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IN | 100054590A | 05 |
Street Address |
2222 TIMBERBROOK TRL |
City | FORT WAYNE |
State | IN |
Zip Code | 46845-9530 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497788848 | Il-sung Kwak | Anesthesiology | 2222 Timberbrook Trl, Fort Wayne, IN 46845-9530 | 2006-07-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
Find all providers in zip 46845 |
Taxonomy Code | 174400000X |
Grouping | Other Service Providers |
Classification | Specialist |
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679078398 | Wright Choice Hairquarters | Specialist | 1815 Fox Point Trl Apt 2, Fort Wayne, IN 46816-2450 | 2018-03-26 |
1225581945 | Hossam Eldine Kamal Youssef | Specialist | 7230 Engle Rd Ste 303, Fort Wayne, IN 46804-2227 | 2016-07-28 |
1245600972 | Pediatric Cardiology Associates | Specialist | 5107 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-10-07 |
1598168197 | Melinda Elise Smith | Specialist | 5812 Maplecrest Rd, Fort Wayne, IN 46835-3840 | 2014-09-27 |
1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
1790076453 | Susan Anne Walstra | Specialist | 4601 Heatherwind Dr, Apt. D, Fort Wayne, IN 46815-7135 | 2011-04-28 |
1265755250 | William A Argus Md PC | Specialist | 7030 Pointe Inverness Way Ste 240, Fort Wayne, IN 46804-7925 | 2010-03-05 |
1033376413 | A Step Ahead Therapies, LLC | Specialist | 6013 Belle Isle Ln, Fort Wayne, IN 46835-1263 | 2008-05-21 |
1932370590 | Kerri Jo Trentacosti | Specialist | 5939 Brighton Meadows Dr, Apt. C, Fort Wayne, IN 46804-7664 | 2008-03-21 |
1649458662 | Bernice Wilson | Specialist | 4202 Buell Dr, Fort Wayne, IN 46807-2743 | 2008-01-31 |
Find all providers in FORT WAYNE |
City | FORT WAYNE |
Zip Code | 46845 |
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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.