Active NPI
Kailee Ruzicka
- Athletic Trainer
- Lockport, IL
National Provider Identifier
1659837276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 16242 Lakeside Dr
Lockport, IL 60441-7027 - Phone
- (630) 200-2707
- NPI assigned
- Feb 19, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
16242 Lakeside Dr
Lockport, IL 60441-7027
Mailing address
16242 Lakeside Dr
Lockport, IL 60441-7027
Phone (630) 200-2707
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1659837276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16242 LAKESIDE DR",
"city": "LOCKPORT",
"state": "IL",
"postal_code": "604417027",
"telephone_number": "630-200-2707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16242 LAKESIDE DR",
"city": "LOCKPORT",
"state": "IL",
"postal_code": "604417027",
"telephone_number": "630-200-2707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUZICKA",
"first_name": "KAILEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-19",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lockport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.