MEDICARE: SARAH SOBOTKA

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	164007047	RI

General Provider Information

NPI Number	:	1548794704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SOBOTKA

Provider Business Mailing Address
First Line	:	619 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5606
Country	:	US
Telephone Number	:	312-627-0444
Fax Number	:	312-648-0155

Provider Business Practice Location Address
First Line	:	619 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5606
Country	:	US
Telephone Number	:	312-627-0444
Fax Number	:	312-648-0155

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

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	04/14/2017

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