MEDICARE: HEALTH LOFT PLLC

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

General Provider Information

NPI Number	:	1912461799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH LOFT PLLC

Provider Business Mailing Address
First Line	:	PO BOX 735912
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5912
Country	:	US
Telephone Number	:	516-998-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 W DIVISION ST # 120
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9024
Country	:	US
Telephone Number	:	855-552-5557
Fax Number	:

Authorized Official
Title or Position	:	BILLING AND CREDENTIALING MANAGER
Name	:	TEAH MICHELLE PHILLIPS
Credential	:
Telephone Number	:	901-205-3999

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	03/17/2026

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Directions to “HEALTH LOFT PLLC ” Practice Location

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