Healthcare Provider Details

I. General information

NPI: 1073579991
Provider Name (Legal Business Name): LORI D MAGER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI D BAKKA

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 N AIRLITE ST
ELGIN IL
60123-4912
US

IV. Provider business mailing address

1800 SYRACUSE LN
SCHAUMBURG IL
60193-3319
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-5461
  • Fax:
Mailing address:
  • Phone: 847-895-8038
  • Fax:

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: