MEDICARE: LORI ANN WELSTEAD MS, RD, LDN

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	164.004199	IL

General Provider Information

NPI Number	:	1598982639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANN WELSTEAD MS, RD, LDN

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4080
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-0019
Fax Number	:	773-834-4037

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4080
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-0019
Fax Number	:	773-834-4037

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/06/2016

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