Active NPI
Michele Karen Sackheim, DDS MSD
- Periodontics
- Bolingbrook, IL
National Provider Identifier
1093943417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 021002075
- Practice address
- 160 E Boughton Rd
Bolingbrook, IL 60440-2014 - Phone
- (630) 759-8940
- NPI assigned
- Jun 24, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 021002075 | IL | Primary |
Addresses
Primary practice location
160 E Boughton Rd
Bolingbrook, IL 60440-2014
Mailing address
160 E Boughton Rd
Bolingbrook, IL 60440-2014
Phone (630) 759-8940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2015 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002075 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1093943417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E BOUGHTON RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604402014",
"telephone_number": "630-759-8940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E BOUGHTON RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604402014",
"telephone_number": "630-759-8940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SACKHEIM",
"first_name": "MICHELE",
"middle_name": "KAREN",
"name_prefix": "Dr.",
"credential": "DDS MSD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-24",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "021002075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.