Provider Demographics
NPI:1558127852
Name:ZACK, LILIAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 YAGGI DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3650
Mailing Address - Country:US
Mailing Address - Phone:630-880-7323
Mailing Address - Fax:
Practice Address - Street 1:2350 N STEMMONS FWY STE F4400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2700
Practice Address - Country:US
Practice Address - Phone:214-456-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered