Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 125073409 | IL |
Y | 2081S0010X | Sports Medicine | 036155443 | IL |
Y | 213ES0000X | Sports Medicine | 036155443 | IL |
NPI | 1245761899 |
---|---|
Provider Name | Dr. Kevin Machino |
First Address | Glenview, IL 60026-1339 |
Second Address | Glenview, IL 60026-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 28/06/2021 |