MARYMINA RESPIRATORY MEDICINE, LLC (NPI# 1083851174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083851174 |
| Entity Type | Organization |
| Organization Name | MARYMINA RESPIRATORY MEDICINE, LLC |
| Practice Address |
1740 Sycamore Washington IL 61571-9799 |
| Practice Telephone | 3093604879 |
| Mailing Telephone | 3093604879 |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2011-07-10 |
| Authorized Official Name | DR. OSSAMA IKLADIOS (PRESIDENT) |
| Authorized Official Telephone | 3093604879 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
025MA069176 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 8065403 | 05 |
| Street Address |
1740 SYCAMORE |
| City | WASHINGTON |
| State | IL |
| Zip Code | 61571-9799 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904504 | Kelly Hornberger | Physical Therapist | 1201 Newcastle Rd., Washington, IL 61571 | 2018-09-01 |
| 1073050407 | Jillyn Cross | Occupational Therapist | 14 Oxford Court, Washington, IL 61571 | 2017-01-24 |
| 1639410772 | Stephen L Dejaynes | Counselor | 100 Hillcrest Drive, Washington, IL 61571 | 2013-03-14 |
| 1184998692 | One Counseling and Wellness | Counselor | 1003 North Cummings Lane, Washington, IL 61571 | 2012-03-01 |
| 1871878371 | M Lisa Kim | Pharmacist | 1700 Saddleridge Ct, Washington, IL 61571 | 2011-10-15 |
| 1073805156 | Skill Sprout International | Behavioral Analyst | 102 Walnut Street, Washington, IL 61571 | 2011-05-09 |
| 1659600948 | Skill Sprout, LLC | Behavioral Analyst | 128 Washington Square, Washington, IL 61571 | 2009-12-15 |
| 1700024916 | Julie Adams | Developmental Therapist | 700 S. Elm, Washington, IL 61571 | 2009-01-26 |
| 1851595128 | Michael John Herman | Dentist | 106 So Cummings Lane, Washington, IL 61571 | 2007-06-12 |
| 1861539132 | Gary Lee Cunningham | Dentist | 5 Laurel Ct., Washington, IL 61571 | 2007-01-30 |
| Find all providers in zip 61571 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598263006 | David C Gross, Md, PC | Internal Medicine | 106 Irving St Nw #412, Washington, DC 20010 | 2018-01-30 |
| 1811424872 | Cristian Dumitrescu | Internal Medicine | 3800 Reservoir Rd Nw Rm M421, Washington, DC 20007-2113 | 2017-05-21 |
| 1942642228 | Luzviminda Peredo-berger | Internal Medicine | 500 12th St Sw Fl 2, Washington, DC 20536-5098 | 2013-07-26 |
| 1154513521 | Joel M. Taubin M.d., P.C. | Internal Medicine | 1145 19th St Nw Ste 504, Washington, DC 20036-3715 | 2007-08-09 |
| 1033267109 | Thomas Michael Fitzpatrick | Internal Medicine | Wramc, Building 2, Room 2j38, 6900 Georgia Avenue, Nw, Washington, DC 20307-0001 | 2007-01-08 |
| 1124197413 | Jeffrey A Kelman | Internal Medicine | 2623 Garfield St Nw, Washington, DC 20008-4103 | 2006-11-08 |
| 1487742250 | Ronald Kurt Poropatich | Internal Medicine | Wramc Bldg2 Pulmonary Critical Care Medicine, 6900 Georgia Ave., Nw, Washington, DC 20307-0001 | 2006-10-10 |
| 1063507515 | Peter Lefort Whitesell | Internal Medicine | 2041 Georgia Ave Nw 5-b01, Main Hospital, Washington, DC 20060 | 2006-10-03 |
| 1629170923 | Truvor Vadym Kuzmowych | Internal Medicine | Dva Medical Center 50 Irving St Nw, Washington, DC 20422-0001 | 2006-09-05 |
| 1407881345 | Daniel Baram | Internal Medicine | 2150 Pennsylvania Ave Nw Ste 416, Gw Mfa, Department of Medicine, Washington, DC 20037 | 2006-07-11 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 61571 |
Please comment or provide details below to improve the information on MARYMINA RESPIRATORY MEDICINE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.