Active NPI
Michelle Therese Novak, ATC
- Athletic Trainer
- Peoria, IL
National Provider Identifier
1770096877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096003270
- Practice address
- 2338 W Van Winkle Way Ste 3300
Peoria, IL 61615-7485 - Phone
- (309) 693-2020
- NPI assigned
- Nov 10, 2017
- Sex
- Female
- 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 | 096003270 | IL | Primary |
Addresses
Primary practice location
2338 W Van Winkle Way Ste 3300
Peoria, IL 61615-7485
Mailing address
1700 W Hickory Grove Rd Apt 4-203
Dunlap, IL 61525-9189
Phone (309) 830-3250
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 |
|---|---|---|---|
| 096003270 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510272000000",
"number": "1770096877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 W HICKORY GROVE RD APT 4-203",
"city": "DUNLAP",
"state": "IL",
"postal_code": "615259189",
"telephone_number": "309-830-3250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2338 W VAN WINKLE WAY STE 3300",
"city": "PEORIA",
"state": "IL",
"postal_code": "616157485",
"telephone_number": "309-693-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVAK",
"first_name": "MICHELLE",
"middle_name": "THERESE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-10",
"last_updated": "2017-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096003270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.