MEDICARE: JAMES SERNEK ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096.003484	IL

General Provider Information

NPI Number	:	1841765070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SERNEK ATC

Provider Business Mailing Address
First Line	:	158 E BAILEY RD APT UNITC
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-3512
Country	:	US
Telephone Number	:	773-255-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 COLLEGE RD
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-0900
Country	:	US
Telephone Number	:	630-829-6154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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