Provider Demographics
NPI:1346322146
Name:PIETRZAK, JAN A (MPH, RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:A
Last Name:PIETRZAK
Suffix:
Gender:M
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12031 S 72ND CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1118
Mailing Address - Country:US
Mailing Address - Phone:708-923-6803
Mailing Address - Fax:
Practice Address - Street 1:645 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5059
Practice Address - Country:US
Practice Address - Phone:773-854-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered