Active NPI
Georges Wakim, LAT
- Athletic Trainer
- Racine, WI
National Provider Identifier
1790102986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1317-39
- Practice address
- 3811 Spring St.
Suite 102
Racine, WI 53405 - Phone
- (262) 687-5838
- Fax
- (262) 687-5895
- NPI assigned
- Mar 25, 2014
- Sex
- Male
- 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 | 1317-39 | WI | Primary |
Addresses
Primary practice location
3811 Spring St.
Suite 102
Racine, WI 53405
Mailing address
3811 Spring St.
Suite 102
Racine, WI 53405
Phone (262) 687-5838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1317-39 | Other | WI | STATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES |
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 |
|---|---|---|---|
| 1317-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395705600000",
"number": "1790102986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3811 SPRING ST.",
"address_2": "SUITE 102",
"city": "RACINE",
"state": "WI",
"postal_code": "53405",
"telephone_number": "262-687-5838",
"fax_number": "262-687-5895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3811 SPRING ST.",
"address_2": "SUITE 102",
"city": "RACINE",
"state": "WI",
"postal_code": "53405",
"telephone_number": "262-687-5838",
"fax_number": "262-687-5895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKIM",
"first_name": "GEORGES",
"credential": "LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-25",
"last_updated": "2014-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1317-39",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES",
"identifier": "1317-39",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.