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NPI Code Detail

MEDICARE: KRISTEN BOTTE RD

MEDICARE: KRISTEN BOTTE 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
1133V00000XRegistered Dietitian164.005161IL

General Provider Information

NPI Number : 1801147566
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN BOTTE RD
Provider Business Mailing Address
First Line : 401 W FULLERTON PKWY APT 904E
Second Line :
City : CHICAGO
State : IL
Zip : 60614-8836
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 333 N MICHIGAN AVE STE 1900
Second Line :
City : CHICAGO
State : IL
Zip : 60601-3994
Country : US
Telephone Number : 773-321-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2012
Last Update Date : 09/21/2012

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Directions to “ KRISTEN BOTTE RD” Practice Location

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