MEDICARE: OLA CZYZEWSKI 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	164.012079	IL

General Provider Information

NPI Number	:	1316730906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLA CZYZEWSKI MS, RD, LDN

Provider Business Mailing Address
First Line	:	431 KELBURN RD APT 212
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4367
Country	:	US
Telephone Number	:	847-975-8943
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 W DAKIN ST APT 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5021
Country	:	US
Telephone Number	:	847-975-8943
Fax Number	:

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

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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