1538101423 NPI number — MR. JAMES KEVIN BUSKIRK P.T.

Table of content: MR. JAMES KEVIN BUSKIRK P.T. (NPI 1538101423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538101423 NPI number — MR. JAMES KEVIN BUSKIRK P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSKIRK
Provider First Name:
JAMES
Provider Middle Name:
KEVIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538101423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMETTE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60091-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-251-2028
Provider Business Mailing Address Fax Number:
847-512-5064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3545 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMETTE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60091-1058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-251-2028
Provider Business Practice Location Address Fax Number:
847-512-5064
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  070004145 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650007085 . This is a "MEDICARE RAILROAD - PALMETTO GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200573902 . This is a "TRANSIT REHABILITATION CENTERS OF CHICAGO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363396874 . This is a "TAX ID PEAK THERAPEUTICS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01634372 . This is a "BCBS GROUP NO." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1618443 . This is a "BCBS IL GROUP ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200573902 . This is a "TAX ID BALANCE CTR OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200573902 . This is a "TRANSIT REHAB CENTERS OF CHICAGO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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