Healthcare Provider Details

I. General information

NPI: 1417569153
Provider Name (Legal Business Name): JULIE ADAMS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 08/22/2020
Certification Date: 08/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1310 CHESTNUT AVE
WILMETTE IL
60091-1618
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-5067
  • Fax: 312-227-9441
Mailing address:
  • Phone: 847-251-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.007355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: