Healthcare Provider Details

I. General information

NPI: 1609411776
Provider Name (Legal Business Name): MIGUEL SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date: 11/03/2025
Reactivation Date: 03/24/2026

III. Provider practice location address

525 TREASURE DR
OSWEGO IL
60543-7801
US

IV. Provider business mailing address

525 TREASURE DR
OSWEGO IL
60543-7801
US

V. Phone/Fax

Practice location:
  • Phone: 630-888-2254
  • Fax:
Mailing address:
  • Phone: 630-888-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096016132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: