MEDICARE: KATHRYN S LEVIN 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
1	133V00000X	Registered Dietitian	164001476	IL

General Provider Information

NPI Number	:	1275691966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN S LEVIN RD

Provider Business Mailing Address
First Line	:	701 N 1ST ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62781-0001
Country	:	US
Telephone Number	:	217-788-3477
Fax Number	:	217-788-5569

Provider Business Practice Location Address
First Line	:	701 N 1ST ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-3757
Country	:	US
Telephone Number	:	217-788-3477
Fax Number	:	217-788-5569

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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Directions to “ KATHRYN S LEVIN RD” Practice Location

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