SAMUEL PARK (NPI# 1720050495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720050495 |
| Entity Type | Individual |
| Full Name | SAMUEL PARK |
| Credential | MD |
| Practice Address |
1400 Charles St Rockford IL 61104-2224 |
| Mailing Address |
Po Box 15785 Loves Park IL 61132-5785 |
| Practice Telephone | 8154894267 |
| Practice Fax Number | 8159663967 |
| Mailing Telephone | 8156547772 |
| Mailing Fax Number | 8156547009 |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2007-07-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
036063669 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036063669 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922363183 | Samuel Park | Preventive Medicine | 2448 Historic Decatur Rd Ste 130, San Diego, CA 92106-6127 | 2012-07-12 |
| 1053607952 | Samuel Joon Park | Internal Medicine | 160 1st St Unit 551, Mineola, NY 11501-5025 | 2011-06-20 |
| 1851504377 | Samuel Sanghong Park | Orthopaedic Surgery | 12 Salt Creek Ln Ste 350, Hinsdale, IL 60521-8612 | 2007-05-08 |
| 1023174752 | Samuel Ryan Park | Anesthesiology | 22 Odyssey Ste 155, Irvine, CA 92618-3194 | 2006-12-28 |
| 1497832661 | Samuel K. Park | Family Medicine | 20072 Sw Birch St Ste 100, Newport Beach, CA 92660-0794 | 2006-11-01 |
| 1740285907 | Samuel Mo Park | Physical Medicine & Rehabilitation | 340 W East Ave, Chico, CA 95926-7238 | 2005-06-15 |
| 1124551239 | Samuel Park | Student in an Organized Health Care Education/Training Program | 1959 Ne Pacific St, Bb-1469, Seattle, WA 98195-0001 | 2017-04-05 |
| 1154853836 | Samuel Park | Physical Therapist | 5000 W National Ave, Milwaukee, WI 53295-0001 | 2017-03-31 |
| 1790237899 | Samuel Park | Student in an Organized Health Care Education/Training Program | 3580 Wilshire Blvd Fl 8, Los Angeles, CA 90010-2505 | 2016-10-25 |
| 1295187136 | Samuel Park IIi | Physical Medicine & Rehabilitation | 1240 Mckee Rd, Dover, DE 19904-1381 | 2016-07-03 |
| Street Address |
1400 CHARLES ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-2224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861464067 | Rebekha Neu | Pathology | 1400 Charles St, Rockford, IL 61104-2224 | 2006-02-02 |
| 1316919103 | Hiului Lau | Pathology | 1400 Charles St, Rockford, IL 61104-2224 | 2006-02-06 |
| 1457323628 | Roger Hilbert | Pathology | 1400 Charles St, Rockford, IL 61104-2224 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861464067 | Rebekha Neu | Pathology | 1400 Charles St, Rockford, IL 61104-2224 | 2006-02-02 |
| 1922088962 | Dennis Navarro Dolleton | Pathology | 616 Regents Ct, Rockford, IL 61107-5064 | 2006-01-17 |
| 1851611982 | Lindsay Ann Brackney | Pathology | 5666 E State St, Rockford, IL 61108-2425 | 2010-06-11 |
| 1568780625 | Tarek Jazaerly | Pathology | 1401 E State St, Rockford, IL 61104-2315 | 2010-05-12 |
| 1114180296 | Eva K Drinka | Pathology | 1401 E State St, Rockford, IL 61104-2315 | 2008-07-08 |
| 1710145453 | Dian Feng | Pathology | 5666 E State St, Rockford, IL 61108-2425 | 2008-05-29 |
| 1164511762 | Korrin Kathryn Meier | Pathology | 1401 E State St, Rockford, IL 61104-2315 | 2006-10-12 |
| 1609839851 | Matthew H Twohig | Pathology | 1401 E State St, Rockford, IL 61104-2315 | 2006-04-10 |
| 1841251451 | James A Harker | Pathology | 2400 N Rockton Ave, Rockford, IL 61103-3655 | 2006-03-31 |
| 1740241991 | Connie M Vitali | Pathology | 2400 N Rockton Ave, Rockford, IL 61103-3655 | 2006-03-29 |
| Find all providers in ROCKFORD | ||||
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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.