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General NPI Number Information
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NPI Number | 1891906269
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Entity Type | Organization
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Legal Business Name | HINSDALE HEALTH AND NUTRITION
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 120 E OGDEN AVE STE 120
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City | HINSDALE
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State | IL
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Zip | 60521-3545
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Country | US
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Telephone | 630-325-5185
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Fax | 630-325-5184
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Provider Business Mailing Address
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Address Line | 120 E OGDEN AVE STE 120
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City | HINSDALE
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State | IL
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Zip | 60521-3545
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Country | US
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Telephone | 630-325-5185
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Fax | 630-325-5184
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. EHTESHAM J GHANI
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Credential | M.D
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Telephone | 630-325-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 036092503
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License Number State | IL
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