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NPI Code Detail

MEDICARE: KAREN REZABEK MMSC, RD, LDN

MEDICARE: KAREN REZABEK MMSC, RD, LDN
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 Dietitian420208IL

General Provider Information

NPI Number : 1902015605
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN REZABEK MMSC, RD, LDN
Provider Business Mailing Address
First Line : 4520 HOME AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-4318
Country : US
Telephone Number : 312-829-1424
Fax Number : 312-850-8431
Provider Business Practice Location Address
First Line : 1426 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1821
Country : US
Telephone Number : 312-829-1424
Fax Number : 312-850-8431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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