Healthcare Provider Details

I. General information

NPI: 1841002003
Provider Name (Legal Business Name): MADISON SMITH RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 59
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

2933 N SHERIDAN RD APT 511
CHICAGO IL
60657-5934
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-1177
  • Fax:
Mailing address:
  • Phone: 513-335-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164.008872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: