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General NPI Number Information
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NPI Number | 1114628625
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Entity Type | Individual
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Provider Name | BENJAMIN WILLIAM PUODZIUNAS RD
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Gender | Male
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 251 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-3055
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Country | US
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Telephone | 312-926-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 305 VILLAGE SPRING LN
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City | REINHOLDS
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State | PA
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Zip | 17569-9448
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Country | US
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Telephone | 717-368-1317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86294379
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License Number State |
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