Provider Demographics
NPI:1134467905
Name:DUPAGEDIETITIANS
Entity Type:Organization
Organization Name:DUPAGEDIETITIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:630-839-9296
Mailing Address - Street 1:3080 OGDEN AVE
Mailing Address - Street 2:104
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1691
Mailing Address - Country:US
Mailing Address - Phone:630-839-9296
Mailing Address - Fax:630-364-1873
Practice Address - Street 1:3080 OGDEN AVE
Practice Address - Street 2:104
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1691
Practice Address - Country:US
Practice Address - Phone:630-839-9296
Practice Address - Fax:630-364-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004325133V00000X
IL164002387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty