DR. BRAD L SUPRENANT (NPI# 1760467377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760467377 |
| Entity Type | Individual |
| Full Name | DR. BRAD L SUPRENANT |
| Credential | DO |
| Practice Address |
500 N Wall St Kankakee IL 60901-2942 |
| Practice Telephone | 8444044787 |
| Practice Fax Number | 8159363243 |
| Mailing Telephone | 8444044787 |
| Mailing Fax Number | 8159363243 |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2020-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
036071427 | IL | Allopathic & Osteopathic Physicians |
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
02001098A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RR MEDICARE | 060030169 | 01 | |
| IN | ANTHEM PIN | 000000095316 | 01 |
| IL | 036071247 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1490 E Walnut St Ste A, Watseka, IL 609701806 | 8154327693 | 8159367228 |
| 375 N Wall St Ste P420, Kankakee, IL 60901 | 8159399400 | 8159399494 |
| Street Address |
500 N WALL ST |
| City | KANKAKEE |
| State | IL |
| Zip Code | 60901-2942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649265026 | Lambros C Chrones | Psychiatry & Neurology | 500 N Wall St, Suite 200, Kankakee, IL 60901-2942 | 2005-09-13 |
| 1477062172 | Cheryl D Rogers | Nurse Practitioner | 500 N Wall St, Kankakee, IL 60901-2942 | 2017-09-25 |
| 1124546221 | Andrew J Donofrio | Physician Assistant | 500 N Wall St, Kankakee, IL 60901-2942 | 2017-09-08 |
| 1245758416 | Elizabeth Ann Wirth | Clinical Nurse Specialist | 500 N Wall St, Kankakee, IL 60901-2942 | 2017-09-07 |
| 1568708667 | Karla Schweigert | Nurse Practitioner | 500 N Wall St, Kankakee, IL 60901-2942 | 2012-12-17 |
| 1588911333 | Shiva Prasad Shashidharan | Internal Medicine | 500 N Wall St, Kankakee, IL 60901 | 2012-08-11 |
| 1295964872 | Amit Zachariah | Internal Medicine | 500 N Wall St, Kankakee, IL 60901-2942 | 2009-07-05 |
| 1992959555 | Dawit Amare | Psychiatry & Neurology | 500 N Wall St, Ste. 200, Kankakee, IL 60901-2942 | 2008-11-10 |
| 1376709758 | Nha T Huynh | Internal Medicine | 500 N Wall St, Kankakee, IL 60901-2942 | 2008-08-05 |
| 1316111693 | Alaa E Abdel-meguid, M.d., S.c. | Internal Medicine | 500 N Wall St, Suite 501, Kankakee, IL 60901-2942 | 2008-04-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558978841 | William Mitsos Dds | Dentist | 1291 S. 7th Ave, Kankakee, IL 60901 | 2020-09-30 |
| 1922653682 | Jody Mcguyer, Lcpc, Cadc Counseling Services, LLC | Counselor | 315 W. Court St., Kankakee, IL 60901 | 2019-08-08 |
| 1700346327 | Sarah Elizabeth Toma | Speech-Language Pathologist | 200 E Court St #708, Kankakee, IL 60901 | 2019-03-20 |
| 1710473160 | Small Talk Speech Services, LLC | Clinic/Center | 1439 W Vanmeter St, Kankakee, IL 60901 | 2018-07-09 |
| 1124538004 | Amy J Green | Physical Therapist | 350 N. Wall Street, Kankakee, IL 60901 | 2017-10-05 |
| 1013457514 | Elizabeth Ann Smith | Registered Nurse | 292 Charlton Lane, Kankakee, IL 60901 | 2017-03-02 |
| 1861931461 | Stacey E. Brown | Nurse Practitioner | 207 N. Schuyler Ave., Kankakee, IL 60901 | 2017-02-15 |
| 1417352105 | Provider Healthcare Services, Inc | Home Health | 555 South Schuyler, Suite 275, Kankakee, IL 60901 | 2014-10-24 |
| 1265850655 | Ronald George Testa | Dentist | 202 N. Schuyler Ave, Kankakee, IL 60901 | 2014-04-02 |
| 1245587898 | Mary Beth Wertz | Registered Nurse | 100 N Jeffery Street, Kankakee, IL 60901 | 2012-08-13 |
| Find all providers in zip 60901 | ||||
| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| 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 |
|---|---|---|---|---|
| 1316059942 | Cardiospecialists Group Ltd | Internal Medicine | 375 N Wall St, Suite 420, Kankakee, IL 60901-3483 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508363185 | Deaconess Specialty Physicians, Inc | Internal Medicine | 1340 Il Highway 1 Ste A, Carmi, IL 62821 | 2018-04-10 |
| 1568637833 | Krishnaswami Sriram | Internal Medicine | 611 Hunter Ln, Lake Forest, IL 60045-4905 | 2008-04-28 |
| 1083712467 | Ohio Valley Heartcare Inc | Internal Medicine | 1405 Locust St, Eldorado, IL 62930-1629 | 2006-09-20 |
| 1912917030 | Martin C Burke | Internal Medicine | 1006 S Michigan Ave, Suite 501, Chicago, IL 60605-2254 | 2006-08-09 |
| 1316998578 | West Suburban Cardiologists, Ltd. | Internal Medicine | 3118 N Ashland Ave, Chicago, IL 60657-3014 | 2006-05-13 |
| 1952359242 | Samer Dibs | Internal Medicine | 2222 W Division St Ste 340, Chicago, IL 60622-2995 | 2006-05-05 |
| 1164483145 | Mehran Jabbarzadeh | Internal Medicine | 900 Technology Way Ste 220, Libertyville, IL 60048-5364 | 2006-03-30 |
| 1497754634 | Rebecca Sue Riepshoff | Internal Medicine | Three Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269-1282 | 2005-07-19 |
| 1093712481 | Erica D Engelstein | Internal Medicine | 7447 W Talcott Ave Ste 222, Chicago, IL 60631-3713 | 2005-06-30 |
| 1861007239 | Marian Heart Rhythm Consultants Sc | Internal Medicine | 2222 W Division St Ste 205, Chicago, IL 60622-3094 | 2020-09-13 |
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| 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.