MEDICARE: EMPATHY RD, LLC

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1255009064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPATHY RD, LLC

Provider Business Mailing Address
First Line	:	1532 W THOMAS ST APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-3969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 W THOMAS ST APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-3969
Country	:	US
Telephone Number	:	773-318-9274
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN, FOUNDER
Name	:	LAURA HERZOG
Credential	:	RD
Telephone Number	:	773-318-9274

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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