Taylor Wolfram, LLC
Dietitian, Registered in La Grange, IL. Organization (NPI-2).
NPI number1124619630
StatusActive
Last updated in NPPESJan 27, 2021
Details
- NPI
- 1124619630
- Entity type
- Organization (NPI-2)
- Legal business name
- Taylor Wolfram, LLC
- Organization subpart
- No
- Enumeration date
- Jan 27, 2021
- Certification date
- Jan 27, 2021
- Last updated
- Jan 27, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Practice location
421 7th AveLa Grange, IL 60525-6409
Phone 312-646-0886
Mailing address
121 W Hillgrove Ave Unit 278La Grange, IL 60525-1011
Authorized official
Taylor Wolfram
Owner
8159807949
Is something wrong?
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