Provider Demographics
NPI:1740562529
Name:KAZMERSKI, KIMBERLY (MS,RD,LD,CSP,CNSD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KAZMERSKI
Suffix:
Gender:F
Credentials:MS,RD,LD,CSP,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N DEARBORN ST
Mailing Address - Street 2:UNIT 15 I
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5057
Mailing Address - Country:US
Mailing Address - Phone:312-643-0812
Mailing Address - Fax:
Practice Address - Street 1:1122 N DEARBORN ST
Practice Address - Street 2:UNIT 15 I
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5057
Practice Address - Country:US
Practice Address - Phone:312-643-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered