Active NPI
Mike J Hickey, ATC,CSCS
- Athletic Trainer
- Addison, IL
National Provider Identifier
1174729487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1415 W Lake St
Addison, IL 60101-1870 - Phone
- (630) 705-1950
- Fax
- (630) 705-1980
- NPI assigned
- Jun 23, 2007
- 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 | IL | Primary |
Addresses
Primary practice location
1415 W Lake St
Addison, IL 60101-1870
Mailing address
1355 Cunat CT Apt 1B
Lake in the Hills, IL 60156-6159
Phone (708) 308-4734
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 |
|---|---|---|---|
| 096001432 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1174729487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1355 CUNAT CT APT 1B",
"city": "LAKE IN THE HILLS",
"state": "IL",
"postal_code": "601566159",
"telephone_number": "708-308-4734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 W LAKE ST",
"city": "ADDISON",
"state": "IL",
"postal_code": "601011870",
"telephone_number": "630-705-1950",
"fax_number": "630-705-1980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKEY",
"first_name": "MIKE",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "ATC,CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-23",
"last_updated": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Addison, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.