MEDICARE: MAUREEN GERDING 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	164008557	IL

General Provider Information

NPI Number	:	1396544037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN GERDING RD

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR STE 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4447
Country	:	US
Telephone Number	:	847-977-5428
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR STE 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4447
Country	:	US
Telephone Number	:	847-977-5428
Fax Number	:

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

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	07/09/2025

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