Healthcare Provider Details

I. General information

NPI: 1568415198
Provider Name (Legal Business Name): MICHELE ESTHER KINZLER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BLANCHARD CIR DANADA WELLNESS CENTER, LOWER LEVEL A
WHEATON IL
60187-1037
US

IV. Provider business mailing address

5N858 DOMINION DR
SAINT CHARLES IL
60175-8224
US

V. Phone/Fax

Practice location:
  • Phone: 630-681-5606
  • Fax:
Mailing address:
  • Phone: 630-584-6407
  • 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: