Provider Demographics
NPI:1598548125
Name:GROTTO, MADISON LEE (MBA, RDN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEE
Last Name:GROTTO
Suffix:
Gender:F
Credentials:MBA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2288
Mailing Address - Country:US
Mailing Address - Phone:331-645-8230
Mailing Address - Fax:
Practice Address - Street 1:150 W SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2288
Practice Address - Country:US
Practice Address - Phone:331-645-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered