Provider Demographics
NPI:1134632797
Name:LOBACZ, ANDREA L (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:LOBACZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S CAN DOTA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3614
Mailing Address - Country:US
Mailing Address - Phone:847-797-1990
Mailing Address - Fax:
Practice Address - Street 1:3285 N ARLINGTON HEIGHTS RD STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1564
Practice Address - Country:US
Practice Address - Phone:847-398-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered