MEDICARE: MRS. KAREN MELISSA KLIMCZAK R.D., L.D.N.

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	164.004727	IL

General Provider Information

NPI Number	:	1770594673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN MELISSA KLIMCZAK R.D., L.D.N.

Provider Business Mailing Address
First Line	:	5061 N PULASKI RD
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	773-539-8181
Fax Number	:	773-539-0039

Provider Business Practice Location Address
First Line	:	5061 N PULASKI RD
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	773-539-8181
Fax Number	:	773-539-0039

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	03/25/2013

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