Provider Demographics
NPI:1558406371
Name:ABURMISHAN, DINA (RD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ABURMISHAN
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 1:7900 N MILWAUKEE AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3165
Mailing Address - Country:US
Mailing Address - Phone:847-581-1160
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 18
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3165
Practice Address - Country:US
Practice Address - Phone:847-581-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211666Medicare PIN
ILK17622Medicare UPIN