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NPI Code Detail

MEDICARE: HEATHER CARMICHAEL EICHORN RD

MEDICARE: HEATHER CARMICHAEL EICHORN 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 Dietitian164.005291IL

General Provider Information

NPI Number : 1073886727
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER CARMICHAEL EICHORN RD
Provider Business Mailing Address
First Line : 3921 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2417
Country : US
Telephone Number : 312-379-9313
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 : 312-540-9955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2012
Last Update Date : 10/10/2019

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Directions to “ HEATHER CARMICHAEL EICHORN RD” Practice Location

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