# NUTRIMEDICOS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376886820
- **Authorized official:** MR. LARRY JENKINS (BILLING MANAGER)
- **Authorized official phone:** (312) 953-0547

## Contact information

- **Practice address:** 1719 W 18TH ST, CHICAGO, IL 60608-4833
- **Practice address phone:** (312) 929-2927
- **Mailing address:** 1719 W 18TH ST, CHICAGO, IL 60608-4833
- **Mailing address phone:** (312) 929-2927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | 036117092 | IL | Yes |

## Other

- **Enumeration date:** 04/03/2013
- **Last updated:** 04/03/2013