Provider Demographics
NPI:1508473711
Name:MADNEK-OXMAN, SUSAN FAITH (RD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FAITH
Last Name:MADNEK-OXMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 WADE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4153
Mailing Address - Country:US
Mailing Address - Phone:847-975-9222
Mailing Address - Fax:
Practice Address - Street 1:1051 WADE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4153
Practice Address - Country:US
Practice Address - Phone:847-975-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003582133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered