Healthcare Provider Details

I. General information

NPI: 1235341322
Provider Name (Legal Business Name): LINDA M BRAAM MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S GARY AVE STE 100
BLOOMINGDALE IL
60108-2227
US

IV. Provider business mailing address

231 S GARY AVE STE 100
BLOOMINGDALE IL
60108-2227
US

V. Phone/Fax

Practice location:
  • Phone: 630-893-9660
  • Fax: 630-893-9668
Mailing address:
  • Phone: 630-893-9660
  • Fax: 630-893-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: