Manczko, Thaddeus
Manczko, Thaddeus is an individual health care provider with primary practice located at 350 N Wall St , Kankakee IL 60901-2901. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as his primary health care specialty. Manczko, Thaddeus can be contacted via phone (815) 933-1671.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medical Services | 207PE0004X | 036-100560 | Illinois |
Profile Details
| NPI number | 1073553004 |
|---|---|
| LBN Legal business name | Manczko, Thaddeus |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 7th, 2006 |
| Last updated | Jun 3rd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073553004 | NPPES |
| Illinois | MEDICAID | 036100560-7 |
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