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NPI Code Detail

MEDICARE: ALICIA KAZARIAN RD, LDN

MEDICARE: ALICIA KAZARIAN RD, 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 Dietitian164.007013IL

General Provider Information

NPI Number : 1245798867
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA KAZARIAN RD, LDN
Provider Business Mailing Address
First Line : 1606 WILLIAMS AVE
Second Line :
City : ROUND LAKE BEACH
State : IL
Zip : 60073-2240
Country : US
Telephone Number : 224-406-2034
Fax Number :
Provider Business Practice Location Address
First Line : 1603 ORRINGTON AVE STE 600
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3860
Country : US
Telephone Number : 312-533-1754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2019
Last Update Date : 03/04/2019

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