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NPI Code Detail

MEDICARE: VIVIAN W BURR RD MNT

MEDICARE: VIVIAN W BURR RD MNT
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
1133N00000XNutritionistIL
2133V00000XRegistered DietitianIL

General Provider Information

NPI Number : 1942378393
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN W BURR RD MNT
Provider Business Mailing Address
First Line : 800 E. 55TH STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60615
Country : US
Telephone Number : 773-702-0660
Fax Number :
Provider Business Practice Location Address
First Line : 800 E 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4906
Country : US
Telephone Number : 773-702-0660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2006
Last Update Date : 09/11/2025

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Directions to “ VIVIAN W BURR RD MNT” Practice Location

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