Active NPI
Alexander Kichakov, LAT
- Athletic Trainer
- Winfield, IL
National Provider Identifier
1659576247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 0 S 050 Winfield Road
Suite 120
Winfield, IL 60190 - Phone
- (630) 653-4743
- Fax
- (630) 653-4912
- NPI assigned
- Jun 15, 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
0 S 050 Winfield Road
Suite 120
Winfield, IL 60190
Mailing address
2400 N Crescent LN
Aurora, IL 60504-6016
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 |
|---|---|---|---|
| 096002307 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659576247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 N CRESCENT LN",
"city": "AURORA",
"state": "IL",
"postal_code": "605046016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "0 S 050 WINFIELD ROAD",
"address_2": "SUITE 120",
"city": "WINFIELD",
"state": "IL",
"postal_code": "60190",
"telephone_number": "630-653-4743",
"fax_number": "630-653-4912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KICHAKOV",
"first_name": "ALEXANDER",
"credential": "LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-15",
"last_updated": "2007-07-08",
"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 Winfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.