Individual
MADELINE KALLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-8387
Mailing address
5000 S 5TH AVE # 120D, HINES, IL 60141-3030
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86212129
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86212129
—
IL
Enumeration date
08/13/2021
Last updated
08/13/2021
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