Healthcare Provider Details

I. General information

NPI: 1164570313
Provider Name (Legal Business Name): DEEPA DESHMUKH MPH,RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 OGDEN AVE
LISLE IL
60532-1691
US

IV. Provider business mailing address

1603 BARKEI DR
BATAVIA IL
60510-8305
US

V. Phone/Fax

Practice location:
  • Phone: 630-839-9296
  • Fax:
Mailing address:
  • Phone: 630-699-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164004325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: