MEDICARE: MRS. DANIELLE ANNE GENENZ MS, RD, LDN, CPT

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	164003059	IL

General Provider Information

NPI Number	:	1356349419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE ANNE GENENZ MS, RD, LDN, CPT

Provider Business Mailing Address
First Line	:	5440 N CUMBERLAND AVE
Second Line	:	STE 225
City	:	CHICAGO
State	:	IL
Zip	:	60656-1531
Country	:	US
Telephone Number	:	847-640-4440
Fax Number	:	847-437-2770

Provider Business Practice Location Address
First Line	:	5440 N CUMBERLAND AVE
Second Line	:	STE 225
City	:	CHICAGO
State	:	IL
Zip	:	60656-1531
Country	:	US
Telephone Number	:	847-640-4440
Fax Number	:	847-437-2770

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/16/2020

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