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NPI Code Detail

MEDICARE: MRS. ELIZABETH CHRISTINE KOUSTIS MS, RDN, LD

MEDICARE: MRS. ELIZABETH CHRISTINE KOUSTIS MS, RDN, LD
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
1133VN1005XRenal Nutrition Registered Dietitian
2133V00000XRegistered Dietitian5503OH

General Provider Information

NPI Number : 1881636918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH CHRISTINE KOUSTIS MS, RDN, LD
Provider Business Mailing Address
First Line : 10701 EAST BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1702
Country : US
Telephone Number : 216-791-3800
Fax Number :
Provider Business Practice Location Address
First Line : 8787 BROOKPARK RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44129-6809
Country : US
Telephone Number : 216-739-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 09/12/2023

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