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NPI Code Detail

MEDICARE: KATHERINE ELIZABETH FOODY RD

MEDICARE: KATHERINE ELIZABETH FOODY 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 Dietitian164.008214IL

General Provider Information

NPI Number : 1295317014
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ELIZABETH FOODY RD
Provider Business Mailing Address
First Line : 160 N WACKER DR UNIT 201
Second Line :
City : CHICAGO
State : IL
Zip : 60606-1633
Country : US
Telephone Number : 312-374-5399
Fax Number : 312-638-6433
Provider Business Practice Location Address
First Line : 160 N WACKER DR UNIT 201
Second Line :
City : CHICAGO
State : IL
Zip : 60606-1633
Country : US
Telephone Number : 312-374-5399
Fax Number : 312-638-6433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2021
Last Update Date : 04/21/2021

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