Active NPI
Waldemar Mysiak, M.D.
- Family Medicine Physician
- Libertyville, IL
National Provider Identifier
1972567717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036099938
- Practice address
- 755 S Milwaukee Ave
Suite 261
Libertyville, IL 60048-3253 - Phone
- (847) 281-1100
- Fax
- (847) 281-1300
- NPI assigned
- Apr 17, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036099938 | IL | Primary |
Addresses
Primary practice location
755 S Milwaukee Ave
Suite 261
Libertyville, IL 60048-3253
Mailing address
755 S Milwaukee Ave
Suite 261
Libertyville, IL 60048-3253
Phone (847) 281-1100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036099938 | Medicaid | IL | |
| 04932174 | Other | IL | BCBS NUMBER |
| 364406567 | Other | IL | TAX ID |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Organizations & group practices 1
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.
-
dba Family Health Center
- Family Medicine Physician
- Libertyville, IL
- NPI 1508163031
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487030400000",
"number": "1972567717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 S MILWAUKEE AVE",
"address_2": "SUITE 261",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483253",
"telephone_number": "847-281-1100",
"fax_number": "847-281-1300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 S MILWAUKEE AVE",
"address_2": "SUITE 261",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483253",
"telephone_number": "847-281-1100",
"fax_number": "847-281-1300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYSIAK",
"first_name": "WALDEMAR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2017-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036099938",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036099938",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "04932174",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "364406567",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.