Active NPI
Kevin Patrick Bresnahan, ATC
- Athletic Trainer
- Tinley Park, IL
National Provider Identifier
1992897847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096001153
- Practice address
- 16651 Harlem Ave
Tinley Park, IL 60477-2581 - Phone
- (708) 444-2467
- Fax
- (708) 444-2758
- NPI assigned
- Sep 29, 2006
- 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 | 096001153 | IL | Primary |
Addresses
Primary practice location
16651 Harlem Ave
Tinley Park, IL 60477-2581
Mailing address
2915 W 97TH St
Evergreen Park, IL 60805-2611
Phone (708) 424-6255
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 |
|---|---|---|---|
| 096001153 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212105600000",
"number": "1992897847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2915 W 97TH ST",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "608052611",
"telephone_number": "708-424-6255",
"fax_number": "708-422-3001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16651 HARLEM AVE",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604772581",
"telephone_number": "708-444-2467",
"fax_number": "708-444-2758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRESNAHAN",
"first_name": "KEVIN",
"middle_name": "PATRICK",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2008-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096001153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.