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Organization
LAKESIDE DIGESTION PLLC
Active
Organization
LAKESIDE DIGESTION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS PALUMBO (OWNER)
(224) 900-7562
Entity
Organization
Contact information
Practice address
501 SHERMAN AVE, EVANSTON, IL 60202-2815
(773) 319-7319
Mailing address
501 SHERMAN AVE, EVANSTON, IL 60202-2815
(224) 900-7562
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164005341
RD LICENSE NICHOLAS PALUMBO
IL
01
—
1861701500
NPI NICHOLAS PALUMBO
—
01
—
248002576
BUSINESS LICENSE LAKESIDE DIGESTION
IL
Enumeration date
01/16/2020
Last updated
01/20/2020
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