Active NPI
Inna Sydorak
- Orthodontics and Dentofacial Orthopedics Dentistry
- La Grange Park, IL
National Provider Identifier
1609302199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 019031036
- Practice address
- 539 N la Grange Rd
La Grange Park, IL 60526-5647 - Phone
- (708) 354-1070
- NPI assigned
- May 3, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 019031036 | IL | Primary |
Addresses
Primary practice location
539 N la Grange Rd
La Grange Park, IL 60526-5647
Mailing address
2222 Fuller CT Apt 1109
Ann Arbor, MI 48105-2392
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 |
|---|---|---|---|
| 019031036 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1609302199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 FULLER CT APT 1109",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 N LA GRANGE RD",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605265647",
"telephone_number": "708-354-1070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SYDORAK",
"first_name": "INNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-03",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "019031036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.