Active NPI
Kevin Paul Wachowiak, LAT/ATC
- Athletic Trainer
- Lake in the Hills, IL
National Provider Identifier
1437556222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003657
- Practice address
- 926 Viewpoint Dr
Lake in the Hills, IL 60156-4908 - Phone
- (630) 877-2419
- NPI assigned
- Nov 23, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 096.003657 | IL | Primary |
Addresses
Primary practice location
926 Viewpoint Dr
Lake in the Hills, IL 60156-4908
Mailing address
926 Viewpoint Dr
Lake in the Hills, IL 60156-4908
Phone (630) 877-2419
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 |
|---|---|---|---|
| 096.003657 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743724800000",
"number": "1437556222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 VIEWPOINT DR",
"city": "LAKE IN THE HILLS",
"state": "IL",
"postal_code": "601564908",
"telephone_number": "630-877-2419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "926 VIEWPOINT DR",
"city": "LAKE IN THE HILLS",
"state": "IL",
"postal_code": "601564908",
"telephone_number": "630-877-2419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACHOWIAK",
"first_name": "KEVIN",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "LAT/ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-23",
"last_updated": "2025-04-04",
"certification_date": "2025-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake in the Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.