ELLEN M HENNECKE (NPI# 1699751156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699751156 |
| Entity Type | Individual |
| Full Name | ELLEN M HENNECKE |
| Credential | DO |
| Practice Address |
3927 W 95th St Evergreen Park IL 60805-1903 |
| Mailing Address |
18141 Dixie Hwy Ste 107 Homewood IL 60430-2238 |
| Practice Telephone | 7089524566 |
| Practice Fax Number | 7089524568 |
| Mailing Telephone | 7087998440 |
| Mailing Fax Number | 7087998446 |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHIELD | 01628066 | 01 |
| Street Address |
3927 W 95TH ST |
| City | EVERGREEN PARK |
| State | IL |
| Zip Code | 60805-1903 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144421017 | Richard E Odonnell Do Sc | Family Medicine | 3927 W 95th St, Evergreen Park, IL 60805-1903 | 2007-05-30 |
| 1780885657 | Ellen M Hennecke Dosc | Family Medicine | 3927 W 95th St, Evergreen Park, IL 60805-1903 | 2007-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254603 | Cynthia Nicole Bucio | Pharmacist | 9400 S. Western, Evergreen Park, N/A 60805 | 2020-10-27 |
| 1124530456 | Foundations Counseling, LLC | Social Worker | 9730 S Western Ave Ste 215, Evergreen Park, IL 60805 | 2017-10-26 |
| 1184147886 | Luke Blaeser | Specialist/Technologist | 2856 W. 97th Pl., Evergreen Park, IL 60805 | 2017-07-25 |
| 1396193322 | Daniel Joseph Bierbaum Howard | Emergency Medicine | 2800 95th St, Emergency Department, Evergreen Park, IL 60805 | 2016-05-31 |
| 1588037873 | Lcr Primary Care LLC | Exclusive Provider Organization | 9237 S.pulaski, Ste. 2s, Evergreen Park, IL 60805 | 2015-11-09 |
| 1447639091 | Nancy Sanchez | Social Worker | 9832 S Utica Ave, Evergreen Park, IL 60805 | 2015-05-28 |
| 1629334743 | Harshad M. Mehta Md Sc | Psychiatry & Neurology | 2850 W. 95th Street, Suite 206, Evergreen Park, IL 60805 | 2012-04-03 |
| 1235407305 | Victoria T Adesina | Pharmacist | 8700 South Kedzie Ave, Evergreen Park, IL 60805 | 2011-12-05 |
| 1891072922 | Zahia-lena Refat Hussien | Pharmacist | 8700 S. Kedzie Ave, Evergreen Park, IL 60805 | 2011-11-03 |
| 1891079091 | Denise Adams | Occupational Therapy Assistant | 9217 S. Kedzie, Evergreen Park, IL 60805 | 2011-10-06 |
| Find all providers in zip 60805 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093973893 | Maureen Theresa Butler | Family Medicine | 2850 W 95th St Ste 403, Evergreen Park, IL 60805-2790 | 2008-05-28 |
| 1194914093 | Alzein Medical Ltd | Family Medicine | 2850 W 95th St Ste 400, Evergreen Park, IL 60805-2755 | 2007-10-17 |
| 1184600207 | Richard E Odonnell | Family Medicine | 3927 W 95th Street, Evergreen Park, IL 60805 | 2005-12-20 |
| 1023376266 | Hasan Suleiman | Family Medicine | 2955 W 95th St, Evergreen Park, IL 60805-2409 | 2012-04-25 |
| 1487970471 | Gabriela Maritza Delgado | Family Medicine | 2850 W 95th St, Suite 403, Evergreen Park, IL 60805-2735 | 2010-04-15 |
| 1073746046 | George Thomas | Family Medicine | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2009-08-25 |
| 1487883831 | Ginny L Hendricks | Family Medicine | 2850 W 95th St, Suite 101, Evergreen Park, IL 60805-2735 | 2009-07-07 |
| 1073706388 | Hugh Med Group Inc | Family Medicine | 2850 W 95th St, Suite #304, Evergreen Park, IL 60805-2735 | 2007-08-20 |
| 1144421017 | Richard E Odonnell Do Sc | Family Medicine | 3927 W 95th St, Evergreen Park, IL 60805-1903 | 2007-05-30 |
| 1780885657 | Ellen M Hennecke Dosc | Family Medicine | 3927 W 95th St, Evergreen Park, IL 60805-1903 | 2007-05-30 |
| Find all providers in EVERGREEN PARK | ||||
| City | EVERGREEN PARK |
| Zip Code | 60805 |
Please comment or provide details below to improve the information on ELLEN M HENNECKE.
| 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.