Sidney Dreyer, MS, ATC

Primary specialty

Sports Medicine (Preventive Medicine) PhysicianTaxonomy code 2083S0010X

License

096004152 Issued in IL

Practice address

1920 Football Dr
Lake Forest, IL 60045-4829

Phone

(847) 739-5403

NPI assigned

Mar 17, 2016

Last updated

Dec 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1639530603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 S CANDLESTICK WAY",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600858670",
            "telephone_number": "605-759-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 FOOTBALL DR",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600454829",
            "telephone_number": "847-739-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DREYER",
        "first_name": "SIDNEY",
        "credential": "MS, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "IL",
            "license": "096004152",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004152",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Preventive Medicine) Physician in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Sports Medicine (Preventive Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.

Verify at the official NPI Registry.