Healthcare Provider Details

I. General information

NPI: 1326431560
Provider Name (Legal Business Name): MICHAEL HEUSER MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12290 SINNETT ST
HUNTLEY IL
60142-6005
US

IV. Provider business mailing address

12290 SINNETT ST
HUNTLEY IL
60142-6005
US

V. Phone/Fax

Practice location:
  • Phone: 815-353-8336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096002377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: