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Individual
DR. KENNETH RIDGE MACEK
Active
Individual
DR. KENNETH RIDGE MACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-117591
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117591
—
IL
01
—
206147213
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP)
IL
01
—
P01258413
MEDICARE RAILROAD (INDIVIDUAL)
IL
Enumeration date
05/03/2007
Last updated
02/18/2014
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