MEDICARE: MRS. LISA BETH ZOBERMAN 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		IL

General Provider Information

NPI Number	:	1356483408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA BETH ZOBERMAN RD, LDN

Provider Business Mailing Address
First Line	:	2923 W BIRCHWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1219
Country	:	US
Telephone Number	:	773-262-5638
Fax Number	:

Provider Business Practice Location Address
First Line	:	DCAM 0411, MC 9006
Second Line	:	5758 S MARYLAND AVE
City	:	CHICAGO
State	:	IL
Zip	:	60637-1470
Country	:	US
Telephone Number	:	773-702-6860
Fax Number	:	773-834-7167

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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