Provider Demographics
NPI:1699105056
Name:MEREDITH, ERIC (RDN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 S OAKENWALD AVE UNIT BW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3706
Mailing Address - Country:US
Mailing Address - Phone:312-296-7974
Mailing Address - Fax:
Practice Address - Street 1:900 E 62ND ST
Practice Address - Street 2:UNIT BW
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-5903
Practice Address - Country:US
Practice Address - Phone:312-296-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006017133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered