Provider Demographics
NPI:1104464486
Name:REMKUS, MICHELLE DENISE (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:REMKUS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2537
Mailing Address - Country:US
Mailing Address - Phone:630-254-8891
Mailing Address - Fax:
Practice Address - Street 1:244 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2537
Practice Address - Country:US
Practice Address - Phone:630-254-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered