Healthcare Provider Details

I. General information

NPI: 1184397226
Provider Name (Legal Business Name): ALEXANDER MATTHEW WINNICKI MS RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W GUNNISON ST APT 203
CHICAGO IL
60640-7864
US

IV. Provider business mailing address

900 W GUNNISON ST APT 203
CHICAGO IL
60640-7864
US

V. Phone/Fax

Practice location:
  • Phone: 335-709-5855
  • Fax:
Mailing address:
  • Phone: 336-709-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: