Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038.007743 | IL |
NPI | 1043583677 |
---|---|
Provider Name | Dr. Ingrid Maes |
First Address | Glenview, IL 60025-3051 |
Second Address | Glenview, IL 60025-3051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2012 |
Last Update Date | 13/02/2012 |