=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740548213
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARILYN A ROTHSCHILD R.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 11/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2003 W FULTON ST STE 105
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-850-3437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 N MILWAUKEE ST SUITE 208
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-800-9030
-----------------------------------------------------
Fax | 888-389-9031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 164.005547
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------