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NPI Code Detail

MEDICARE: LORI D MAGER RD

MEDICARE: LORI D MAGER RD
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 DietitianIL

General Provider Information

NPI Number : 1073579991
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI D MAGER RD
Provider Business Mailing Address
First Line : 1800 SYRACUSE LN
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60193-3319
Country : US
Telephone Number : 847-895-8038
Fax Number :
Provider Business Practice Location Address
First Line : 77 N AIRLITE ST
Second Line :
City : ELGIN
State : IL
Zip : 60123-4912
Country : US
Telephone Number : 847-888-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2006
Last Update Date : 07/08/2007

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Directions to “ LORI D MAGER RD” Practice Location

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