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NPI Code Detail

MEDICARE: EMILY SIMO MS RDN LDN

MEDICARE: EMILY SIMO MS RDN LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian164.008118IL

General Provider Information

NPI Number : 1043976038
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY SIMO MS RDN LDN
Provider Business Mailing Address
First Line : 629 W CROCKETT AVE
Second Line :
City : ELMHURST
State : IL
Zip : 60126-1855
Country : US
Telephone Number : 630-352-8813
Fax Number :
Provider Business Practice Location Address
First Line : 3921 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2417
Country : US
Telephone Number : 630-352-8813
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2021
Last Update Date : 11/13/2021

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