Individual
MRS. MICHEL D HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., LDN, CDE
Contact information
Practice address
3523 N LINCOLN AVE, CHICAGO, IL 60657-1137
(773) 929-6262
Mailing address
4356 N KENMORE AVE, APT 101, CHICAGO, IL 60613-1330
(312) 550-3612
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164003376
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164.003376
LICENSED DIETITIAN NUTRITIONIST
IL
01
—
20120370
CERTIFIED DIABETES EDUCATOR
IL
01
—
46-5085580
TAX ID
IL
Enumeration date
08/19/2006
Last updated
03/19/2014
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