Healthcare Provider Details

I. General information

NPI: 1891065751
Provider Name (Legal Business Name): ELISA MARIE BUZINSKI MS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NORTH BLVD
OAK PARK IL
60301-1351
US

IV. Provider business mailing address

1834 N 78TH AVE
ELMWOOD PARK IL
60707-3637
US

V. Phone/Fax

Practice location:
  • Phone: 708-524-2445
  • Fax:
Mailing address:
  • Phone: 708-205-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: