Basic Information
| Provider Information | |||||||||
| NPI: | 1548512221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | RD, LDN. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 OAK GROVE LN | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479031394 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 N WESTMORELAND RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357647 | ||||||||
| FaxNumber: | 8475358109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2012 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164.005190 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.