DR. THADDEUS MANCZKO M.D. NPI 1073553004

NPI Information

  • NPI: 1073553004
  • Provider Name: DR. THADDEUS MANCZKO, M.D.
  • Classification: Emergency Medicine - 207PE0004X
  • Specialization: Emergency Medical Services
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 350 N WALL ST
    KANKAKEE, IL
    ZIP 60901
  • Phone: (815) 933-1671

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NPI Details

DR. Thaddeus Manczko, M.D. is an emergency medical services emergency medicine in Kankakee, IL. The provider is an emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. DR. Thaddeus Manczko, M.D. NPI is 1073553004. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

350 N WALL ST
KANKAKEE, IL
ZIP 60901-901
Phone: (815) 933-1671

The NPI 1073553004 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only (HCPCS:93010)
  • Emergency department visit for problem of high severity (HCPCS:99284)
  • Emergency department visit for life threatening or functioning severity (HCPCS:99285)
  • Emergency department visit for problem of moderate severity (HCPCS:99283)
  • Critical care, first 30-74 minutes (HCPCS:99291)

The enumeration date for this NPI number is 6/7/2006 and was last updated on 6/3/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207PE0004XEmergency MedicineEmergency Medical Services036-100560ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1036100560-7MEDICAIDILLINOIS
2H03041MEDICARE UPINILLINOIS
3L89457MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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