Healthcare Provider Details

I. General information

NPI: 1659142933
Provider Name (Legal Business Name): ALEXA KUZIEL MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W OGDEN AVE # 2
CHICAGO IL
60608-1647
US

IV. Provider business mailing address

3534 N WILTON AVE APT 2
CHICAGO IL
60657-1709
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.008668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: