Individual
DR. KENNETH RIDGE MACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
28375 DAVIS PKWY, SUITE 901, WARRENVILLE, IL 60555-3030
(630) 653-4240
(630) 255-4034
Mailing address
28375 DAVIS PKWY, SUITE 901, WARRENVILLE, IL 60555-3030
(630) 653-4240
(630) 255-4034
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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