Active NPI
William E Sobodas II, ATC
- Athletic Trainer
- Shorewood, IL
National Provider Identifier
1104057264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096-002677
- Practice address
- 972 Brook Forest Ave
Shorewood, IL 60404-8807 - Phone
- (815) 439-4938
- NPI assigned
- Aug 6, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096-002677 | IL | Primary |
Addresses
Primary practice location
972 Brook Forest Ave
Shorewood, IL 60404-8807
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096-002677 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1104057264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "972 BROOK FOREST AVE",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604048807",
"telephone_number": "815-439-4938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBODAS",
"first_name": "WILLIAM",
"middle_name": "E",
"name_suffix": "II",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-06",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096-002677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.