Ellen M Hennecke Dosc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ELLEN M HENNECKE DOSC

Practice address

3927 W 95TH St
Evergreen Park, IL 60805-1903

Phone

(708) 799-8440

NPI assigned

May 30, 2007

Organization subpart

No

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

Authorized official

Name

Kim Wylie

Title

Office Manager

Phone

(708) 799-8440

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard E Odonnell, DO

  • Family Medicine Physician
  • Evergreen Park, IL
  • NPI 1184600207
  NPD (past)

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780885657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18141 DIXIE HWY STE 107",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051903",
            "telephone_number": "708-799-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN M HENNECKE DOSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYLIE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-799-8440"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "01628066",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vida Bernadette Dyson, PH.D.
• Carly Scot Eakin, PA-C
• Kristin Egan
• Joe Eggebeen, M.D.
• Krystle Ekhoff, RN, IBCLC
• John Robert Elsen, M.D.
• John C Elser, M.D.
• Haley Suzanne Elson, LCSW
• Endocrine Diabetes Clinic LTD
• Englewood Community Outreach

• Family Medicine Physician in Evergreen Park, IL
• Providers in Evergreen Park, 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 Aug 22, 2020; 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.