Healthcare Provider Details

I. General information

NPI: 1609861848
Provider Name (Legal Business Name): MRS. VINAY KUMARI GARG
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

6645 GOLF RD
MORTON GROVE IL
60053-1322
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-8165
  • Fax: 773-702-3900
Mailing address:
  • Phone: 773-702-8165
  • Fax: 773-702-3900

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: