Provider Demographics
NPI:1558967588
Name:CHICAGOLAND DIETITIANS INC
Entity Type:Organization
Organization Name:CHICAGOLAND DIETITIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRISAKTHISOLACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-641-0257
Mailing Address - Street 1:16 WILLOW BAY DR
Mailing Address - Street 2:
Mailing Address - City:S BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 WILLOW BAY DR
Practice Address - Street 2:
Practice Address - City:S BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7114
Practice Address - Country:US
Practice Address - Phone:847-641-0257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty