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NPI Code Detail

MEDICARE: MRS. MICHEL D HARRIS R.D., LDN, CDE

MEDICARE: MRS. MICHEL D HARRIS R.D., LDN, CDE
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
1133V00000XRegistered Dietitian164003376IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1164.003376OTHERILLICENSED DIETITIAN NUTRITIONIST
220120370OTHERILCERTIFIED DIABETES EDUCATOR
346-5085580OTHERILTAX ID

General Provider Information

NPI Number : 1427162056
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHEL D HARRIS R.D., LDN, CDE
Provider Business Mailing Address
First Line : 4356 N KENMORE AVE
Second Line : APT 101
City : CHICAGO
State : IL
Zip : 60613-1330
Country : US
Telephone Number : 312-550-3612
Fax Number :
Provider Business Practice Location Address
First Line : 3523 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1137
Country : US
Telephone Number : 773-929-6262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 03/19/2014

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