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NPI Code Detail

MEDICARE: BRIAN JOSEPH DUGAN RDN

MEDICARE: BRIAN JOSEPH DUGAN RDN
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1093387318
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN JOSEPH DUGAN RDN
Provider Business Mailing Address
First Line : 2611 W RICE ST APT 2F
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4544
Country : US
Telephone Number : 347-668-8329
Fax Number :
Provider Business Practice Location Address
First Line : 160 N WACKER DR UNIT 201
Second Line :
City : CHICAGO
State : IL
Zip : 60606-1633
Country : US
Telephone Number : 855-552-5557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2021
Last Update Date : 07/15/2021

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