Provider Demographics
NPI:1134203979
Name:KAMYSZ, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KAMYSZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1311
Mailing Address - Country:US
Mailing Address - Phone:847-409-9729
Mailing Address - Fax:847-463-6261
Practice Address - Street 1:408 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1311
Practice Address - Country:US
Practice Address - Phone:847-409-9729
Practice Address - Fax:847-463-6261
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360846882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4923631OtherBCBS ID
IL202926OtherGROUP PTAN
IL212545OtherGROUP PTAN
IL036084688Medicaid
IL212545OtherGROUP PTAN
F33792Medicare UPIN
IL202926005Medicare PIN