MEDICARE: NUTRITION ENTERPIRSES

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	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist
3	133V00000X	Registered Dietitian	800034	MI
4	133VN1005X	Renal Nutrition Registered Dietitian
5	133VN1006X	Metabolic Nutrition Registered Dietitian
6	133VN1004X	Pediatric Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1558698613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION ENTERPIRSES

Provider Business Mailing Address
First Line	:	13183 BACKUS ST
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-1147
Country	:	US
Telephone Number	:	734-444-6720
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 RENAISSANCE CTR STE 2600
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48243-1502
Country	:	US
Telephone Number	:	734-444-6720
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GAIL KING
Credential	:	RD
Telephone Number	:	734-444-6720

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	06/22/2020

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Directions to “NUTRITION ENTERPIRSES ” Practice Location

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