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Individual

MICHAEL MYNIHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
528 W WELLINGTON AVE, 106, CHICAGO, IL 60657-5413
(419) 779-6096
Mailing address
528 W WELLINGTON AVE, 106, CHICAGO, IL 60657-5413
(419) 779-6096

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.006996
IL

Other

Enumeration date
11/30/2016
Last updated
11/30/2016
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