Provider Demographics
NPI:1184397226
Name:WINNICKI, ALEXANDER MATTHEW (MS RD)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:MATTHEW
Last Name:WINNICKI
Suffix:
Gender:M
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W GUNNISON ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7864
Mailing Address - Country:US
Mailing Address - Phone:336-709-5855
Mailing Address - Fax:
Practice Address - Street 1:900 W GUNNISON ST APT 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7864
Practice Address - Country:US
Practice Address - Phone:335-709-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management