Provider Demographics
NPI:1356483408
Name:ZOBERMAN, LISA BETH (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:ZOBERMAN
Suffix:
Gender:F
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 1:2923 W BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1219
Mailing Address - Country:US
Mailing Address - Phone:773-262-5638
Mailing Address - Fax:
Practice Address - Street 1:DCAM 0411, MC 9006
Practice Address - Street 2:5758 S MARYLAND AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-702-6860
Practice Address - Fax:773-834-7167
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
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