| Dr Thaddeus Manczko, MD | |
|
350 N Wall St, Kankakee, IL 60901-2901 | |
| (815) 933-1671 | |
| Not Available |
| Full Name | Dr Thaddeus Manczko |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine - Emergency Medical Services |
| Location | 350 N Wall St, Kankakee, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073553004 | NPI | - | NPPES |
| 036100560-7 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207PE0004X | Emergency Medicine - Emergency Medical Services | 036-100560 (Illinois) | Primary |
| Entity Name | Travis County Emergency Physicians Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962440933 PECOS PAC ID: 0840289468 Enrollment ID: O20040510000492 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Thaddeus Manczko, MD 2000 Green Rd, Suite 300, Ann Arbor, MI 48105-1598 Ph: (734) 995-3764 | Dr Thaddeus Manczko, MD 350 N Wall St, Kankakee, IL 60901-2901 Ph: (815) 933-1671 |
Dr. Renee Lori Peksa-sink, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 350 N Wall St, Kankakee, IL 60901 Phone: 815-935-7500 | |
Dr. Vernell Johnson Iii, M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 500 W Court St, Kankakee, IL 60901 Phone: 815-937-2100 | |
Dr. Glenn Casimiro Gomes, M.D., M.P.H Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 375 N Wall St, Kankakee, IL 60901 Phone: 815-935-7500 | |
Steven Decker, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 350 N Wall St, Kankakee, IL 60901 Phone: 815-933-1671 | |
Dr. Brian Crowley, D.O. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 500 W Court St, Kankakee, IL 60901 Phone: 815-937-2100 | |
John Lacheta, DO Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 350 N Wall St, Kankakee, IL 60901 Phone: 815-933-1671 |