MEDICARE: CARLY N TRUEGER 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	164004400	IL
2	133V00000X	Registered Dietitian	48006889	NY

General Provider Information

NPI Number	:	1396920765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY N TRUEGER RD

Provider Business Mailing Address
First Line	:	710 N FAIRBANKS CT
Second Line	:	SUITE 7-121
City	:	CHICAGO
State	:	IL
Zip	:	60611-3013
Country	:	US
Telephone Number	:	312-926-7437
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 N FAIRBANKS CT
Second Line	:	SUITE 7-121
City	:	CHICAGO
State	:	IL
Zip	:	60611-3013
Country	:	US
Telephone Number	:	312-926-7437
Fax Number	:

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	06/21/2016

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Directions to “ CARLY N TRUEGER RD” Practice Location

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