=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912461799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH LOFT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2019
-----------------------------------------------------
Last Update Date | 03/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2027 W DIVISION ST # 120
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-9024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-552-5557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 735912
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-5912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-998-5053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AND CREDENTIALING MANAGER
-----------------------------------------------------
Name | TEAH MICHELLE PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-205-3999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------