Organization
BODY AND MIND MEDICAL
Active
Organization
BODY AND MIND MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINIC GAZIANO M.D. (PRESIDENT)
(773) 988-2220
Entity
Organization
Contact information
Practice address
2222 W DIVISION ST, SUITE 130, CHICAGO, IL 60622-2717
(773) 252-4848
(773) 252-8484
Mailing address
2222 W DIVISION ST, SUITE 130, CHICAGO, IL 60622-2717
(773) 252-4848
(773) 252-8484
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
164006794
IL
207R00000X
Internal Medicine Physician
Primary
036091770
IL
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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