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General NPI Number Information
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NPI Number | 1376829531
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL KACER ATC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 411 LOWELL DR
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-2927
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Country | US
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Telephone | 847-742-6051
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Fax |
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Provider Business Mailing Address
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Address Line | 1685 W HIGGINS RD #200
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-6955
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Country | US
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Telephone | 847-730-2708
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Fax | 847-885-4765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.002735
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License Number State | IL
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