Active NPI
Theodore E Dastych, M.D.
- Internal Medicine Physician
- Joliet, IL
National Provider Identifier
1205084431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036051213
- Practice address
- 3237 Oakwood Dr
Joliet, IL 60431-4841 - Phone
- (815) 741-1126
- NPI assigned
- Aug 29, 2008
- Last updated
- Aug 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036051213 | IL | Primary |
Addresses
Primary practice location
3237 Oakwood Dr
Joliet, IL 60431-4841
Mailing address
3237 Oakwood Dr
Joliet, IL 60431-4841
Phone (815) 741-1126
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036051213 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219968000000",
"number": "1205084431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3237 OAKWOOD DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604314841",
"telephone_number": "815-741-1126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3237 OAKWOOD DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604314841",
"telephone_number": "815-741-1126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASTYCH",
"first_name": "THEODORE",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-29",
"last_updated": "2008-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036051213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.