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NPI Code Detail

MEDICARE: THE ANGELO METHOD TAM LLC

MEDICARE: THE ANGELO METHOD TAM LLC
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
1133VN1006XMetabolic Nutrition Registered Dietitian
2133VN1101XGerontological Nutrition Registered Dietitian
3133VN1201XObesity and Weight Management Nutrition Registered Dietitian
4133VN1501XSports Dietetics Nutrition Registered Dietitian
5136A00000XRegistered Dietetic Technician
6132700000XDietary Manager
7133N00000XNutritionist
8133V00000XRegistered Dietitian
9133VN1005XRenal Nutrition Registered Dietitian
10133NN1002XNutrition Education Nutritionist

General Provider Information

NPI Number : 1497228456
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE ANGELO METHOD TAM LLC
Provider Business Mailing Address
First Line : 5440 N CUMBERLAND AVE STE 225
Second Line :
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 STE 225
Second Line :
City : CHICAGO
State : IL
Zip : 60656-1531
Country : US
Telephone Number : 847-640-4440
Fax Number : 847-437-2770
Authorized Official
Title or Position : OWNER
Name : DR. PATRICK ANGELO JR.
Credential : MD
Telephone Number : 847-640-4440
Provider Enumeration Date : 01/02/2019
Last Update Date : 06/23/2020

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