Individual
DR. THADDEUS MANCZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 933-1671
Mailing address
2000 GREEN RD, SUITE 300, ANN ARBOR, MI 48105-1598
(734) 995-3764
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036-100560
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100560-7
—
IL
Enumeration date
06/07/2006
Last updated
06/03/2008
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