| Doctor Name: | SUSAN KAGEN PODELL |
| NPI Number: | 1053456384 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 560 N Midlothian Rd Suite 400 Mundelein, IL - 600601654 |
| Business Phone Number: | 8478378442 |
| Business Fax Number: | 8478378542 |
| Mailing Address: | 560 N Midlothian Rd, Suite 400 MUNDELEIN |
| State: | IL |
| Postal Code: | 600601654 |
| Phone Number: | 8478378442 |
| Fax Number: | 8478378542 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |