MEDICARE: MARY-CLAIRE RUNCHEY MS, 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
1	133V00000X	Registered Dietitian	164.008724	IL

General Provider Information

NPI Number	:	1255078770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-CLAIRE RUNCHEY MS, RD, LDN

Provider Business Mailing Address
First Line	:	4842 N KILPATRICK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1725
Country	:	US
Telephone Number	:	773-931-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	4842 N KILPATRICK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1725
Country	:	US
Telephone Number	:	773-931-7944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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