Thaddeus Manczko, M.D.

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

036-100560 Issued in IL

Practice address

350 N Wall St
Kankakee, IL 60901-2901

Phone

(815) 933-1671

NPI assigned

Jun 7, 2006

Last updated

Jun 3, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Travis County Emergency Physicians PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1962440933
  Medicare reassignment NPD
• Acute Care Specialists II, LTD

  • Emergency Medicine Physician
  • Glendale Heights, IL
  • NPI 1205974433
  NPD (past)
• Advocate North Side Health Network

  dba Advocate Pharmacy #1510

  • Institutional Pharmacy
  • Chicago, IL
  • NPI 1114645470
  NPD (past)
• Emergency Care Physician Services-Blue Island LTD

  • Emergency Medicine Physician
  • Blue Island, IL
  • NPI 1558524793
  NPD (past)
• Epmg of Illinois LLC

  • Emergency Medicine Physician
  • Kankakee, IL
  • NPI 1528098902
  NPD (past)
• Illinois Emergency Medicine Specialists, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bolingbrook, IL
  • NPI 1003150962
  NPD (past)
• Midway Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Waukegan, IL
  • NPI 1447397526
  NPD (past)
• Suburban Emergency Physicians Group, SC

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1245210038
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1073553004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GREEN RD",
            "address_2": "SUITE 300",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051598",
            "telephone_number": "734-995-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012901",
            "telephone_number": "815-933-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCZKO",
        "first_name": "THADDEUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036-100560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100560-7",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judith D Magdziarz, NP
• Maggie Ullrich LLC
• Josephine Majka
• Bonita L Malinowski, MS RD CSR LDN
• Jasmine Mathew Maly, M.D.
• Manor Care of Kankakee Il LLC (ManorCare Health Services-Kankakee)
• Vicky Lynn Mansberger, R.D.
• Thomas Paul Marcotte, RPH
• Andrew Tariao Mariano, DO
• Sara Joy Marion, PTA

• Emergency Medical Services (Emergency Medicine) Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.