Provider Demographics
NPI:1235341322
Name:BRAAM, LINDA M (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BRAAM
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S GARY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2227
Mailing Address - Country:US
Mailing Address - Phone:630-893-9660
Mailing Address - Fax:630-893-9668
Practice Address - Street 1:231 S GARY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2227
Practice Address - Country:US
Practice Address - Phone:630-893-9660
Practice Address - Fax:630-893-9668
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21586Medicare UPIN