MEDICARE: HEATHER CARMICHAEL EICHORN RD

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	133V00000X	Registered Dietitian	164.005291	IL

General Provider Information

NPI Number	:	1073886727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CARMICHAEL EICHORN RD

Provider Business Mailing Address
First Line	:	1755 E 55TH ST APT 1204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5977
Country	:	US
Telephone Number	:	312-292-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 E 55TH ST APT 1204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5977
Country	:	US
Telephone Number	:	312-292-9793
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	01/06/2026

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