Provider Demographics
NPI:1750739165
Name:MIDWEST DIETITIAN, INC.
Entity type:Organization
Organization Name:MIDWEST DIETITIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CEDRD
Authorized Official - Phone:630-487-7283
Mailing Address - Street 1:4300 COMMERCE CT STE 250
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3698
Mailing Address - Country:US
Mailing Address - Phone:630-487-7283
Mailing Address - Fax:630-305-8549
Practice Address - Street 1:4300 COMMERCE CT STE 250
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3698
Practice Address - Country:US
Practice Address - Phone:630-487-7283
Practice Address - Fax:630-305-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL727118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty