NPIMap

Individual provider Active NPI

Thaddeus Holgado, C.O.

  • Orthotist
  • Mequon, WI
National Provider Identifier
1699140814
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OrthotistTaxonomy code 222Z00000X
License
213000212 Issued in IL
Practice address
12075 Corporate Pkwy
Suite 120
Mequon, WI 53092-2665
Phone
(844) 447-5894
NPI assigned
Dec 14, 2015
Last updated
Dec 14, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotist 222Z00000X 213000212 IL Primary

Addresses

Primary practice location

12075 Corporate Pkwy
Suite 120
Mequon, WI 53092-2665

Mailing address

720 E. Butterfield Road
Suite 180
Lombard, IL 60148
Phone (630) 627-5383

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

State licenses

LicenseStateTypeSpecialty
213000212ILMDOrthotist

Practice roles

OrganizationSpecialtyStatusNew patients
Cranial Technologies Inc. Past Accepting new patients
Cranial Technologies Inc Past Accepting new patients
Cranial Technologies, Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1699140814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 E. BUTTERFIELD ROAD",
            "address_2": "SUITE 180",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "60148",
            "telephone_number": "630-627-5383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12075 CORPORATE PKWY",
            "address_2": "SUITE 120",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530922665",
            "telephone_number": "844-447-5894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLGADO",
        "first_name": "THADDEUS",
        "name_prefix": "Mr.",
        "credential": "C.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "IL",
            "license": "213000212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.