Healthcare Provider Details

I. General information

NPI: 1710344601
Provider Name (Legal Business Name): MARTHA KATHLEEN TURNER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 5100, NEPHROLOGY
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5841 S MARYLAND AVE MC 5100, NEPHROLOGY
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-2920
  • Fax:
Mailing address:
  • Phone: 773-702-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164006605
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1034428
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: