Nicholas George Tzanetakos, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036066510 Issued in IL

Practice address

99 Boulder Hill Pass
Montgomery, IL 60538

Phone

(630) 897-2848

Fax

(630) 897-4498

NPI assigned

Feb 2, 2007

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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 and National Provider Directory roles.

• Rush-Copley Medical Group

  • Pediatrics Physician
  • Oswego, IL
  • NPI 1629265764

  Family Medicine

  NPD
• Rush-Copley Medical Group, NFP

  • Family Medicine Physician
  • Aurora, IL
  • NPI 1093075848
  NPD

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499385600000",
    "number": "1720126535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DRIVE",
            "address_2": "SUITE 230",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "60504",
            "telephone_number": "630-499-2404",
            "fax_number": "630-499-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 BOULDER HILL PASS",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "60538",
            "telephone_number": "630-897-2848",
            "fax_number": "630-897-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TZANETAKOS",
        "first_name": "NICHOLAS",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2017-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036066510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066510",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Transparent Dental Group
• Cynthia M Travnicek, LCPC, BCC, CH.T
• Maria Belen Trujillo
• Tu Bella Inc.
• Lisette Tzanetakos Solomon, MD
• Tracey Anne Uher, S.L.P.A.
• Valley Imaging VT, LLC
• Valley View Dental - Montgomery LLC
• Valley View Dental Group LLC
• Maria Vander Pluym

• Family Medicine Physician in Montgomery, IL
• Providers in Montgomery, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2017; 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.