| Nutrition Balance Llc | |
|
22811 Greater Mack Ave Suite 105 Saint Clair Shores MI 48080-2021 | |
| (586) 778-4877 | |
| (586) 778-3004 |
| Full Name | Nutrition Balance Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 22811 Greater Mack Ave, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Susanne E Consiglio (REGISTERED DIETITIAN) |
| Authorized Official Contact | 5867784877 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nutrition Balance Llc 22811 Greater Mack Ave Suite 105 Saint Clair Shores MI 48080-2021 Ph: (586) 778-4877 | Nutrition Balance Llc 22811 Greater Mack Ave Suite 105 Saint Clair Shores MI 48080-2021 Ph: (586) 778-4877 |
| NPI Number | 1275958118 |
|---|---|
| Provider Enumeration Date | 03/01/2014 |
| Last Update Date | 03/01/2014 |
| Medicare PECOS PAC ID | 8527299411 |
|---|---|
| Medicare Enrollment ID | O20140317002063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275958118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 00595403 (Michigan) | Primary |
| Provider Name | Susanne E Consiglio |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1164453114 PECOS PAC ID: 1557365814 Enrollment ID: I20060830000056 |
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