Provider Demographics
NPI:1649588922
Name:JOHN W. KAMYSZ, M.D.
Entity Type:Organization
Organization Name:JOHN W. KAMYSZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAMYSZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-848-5225
Mailing Address - Street 1:408 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1311
Mailing Address - Country:US
Mailing Address - Phone:847-848-5225
Mailing Address - Fax:847-463-6261
Practice Address - Street 1:501 N RIVERSIDE DR STE 213
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5918
Practice Address - Country:US
Practice Address - Phone:847-625-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN W. KAMYSZ, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084688282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3644070316003101Medicaid
ILF33792Medicare UPIN