Active NPI
Sophia Maria Kecala
- Psychiatry Physician
- Elmhurst, IL
National Provider Identifier
1790390722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 36-060984
- Practice address
- 533 W North Ave
Elmhurst, IL 60126-2135 - Phone
- (630) 279-3222
- Fax
- (630) 279-3230
- NPI assigned
- Sep 15, 2020
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 36-060984 | IL | Primary |
Addresses
Primary practice location
533 W North Ave
Elmhurst, IL 60126-2135
Mailing address
16561 135TH St
Lemont, IL 60439-4717
Phone (630) 624-5427
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 |
|---|---|---|---|
| 36-060984 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1790390722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16561 135TH ST",
"city": "LEMONT",
"state": "IL",
"postal_code": "604394717",
"telephone_number": "630-624-5427",
"fax_number": "630-279-3230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "533 W NORTH AVE",
"city": "ELMHURST",
"state": "IL",
"postal_code": "601262135",
"telephone_number": "630-279-3222",
"fax_number": "630-279-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KECALA",
"first_name": "SOPHIA",
"middle_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-15",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "36-060984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.