Active NPI
Wilson Kibungei Malit, OTR/L
- Contractor
- Springfield, IL
National Provider Identifier
1154663045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 056003593
- Practice address
- 555 W Carpenter St
Springfield, IL 62702-4905 - Phone
- (217) 525-1880
- NPI assigned
- Mar 19, 2013
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 056003593 | IL | Primary |
Addresses
Primary practice location
555 W Carpenter St
Springfield, IL 62702-4905
Mailing address
605 Kenyon Dr
Springfield, IL 62704-1412
Phone (217) 416-0272
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1154663045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 KENYON DR",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627041412",
"telephone_number": "217-416-0272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 W CARPENTER ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627024905",
"telephone_number": "217-525-1880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALIT",
"first_name": "WILSON",
"middle_name": "KIBUNGEI",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-19",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "IL",
"license": "056003593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.