Provider Demographics
NPI:1225666001
Name:OSBORN, SLOAN MICHAEL (RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:SLOAN
Middle Name:MICHAEL
Last Name:OSBORN
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 LIMESTONE LN
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-1239
Mailing Address - Country:US
Mailing Address - Phone:708-606-6969
Mailing Address - Fax:
Practice Address - Street 1:2063 LIMESTONE LN
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-1239
Practice Address - Country:US
Practice Address - Phone:708-606-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006957133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered