Active NPI
Tanner Maksymicz
- Athletic Trainer
- Macomb, IL
National Provider Identifier
1457807414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096004259
- Practice address
- 1 University Cir
Macomb, IL 61455-1367 - Phone
- (765) 891-0503
- NPI assigned
- Aug 30, 2016
- 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 | 096004259 | IL | Primary |
Addresses
Primary practice location
1 University Cir
Macomb, IL 61455-1367
Mailing address
700 Linden LN
Macomb, IL 61455-1076
Phone (765) 891-0503
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 |
|---|---|---|---|
| 096004259 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1457807414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 LINDEN LN",
"city": "MACOMB",
"state": "IL",
"postal_code": "614551076",
"telephone_number": "765-891-0503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 UNIVERSITY CIR",
"city": "MACOMB",
"state": "IL",
"postal_code": "614551367",
"telephone_number": "765-891-0503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAKSYMICZ",
"first_name": "TANNER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-30",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096004259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.