Provider Demographics
NPI:1679392500
Name:KOHUT, LESLIE R (MD, RDN, LDN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:KOHUT
Suffix:
Gender:F
Credentials:MD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MARION LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-6666
Mailing Address - Country:US
Mailing Address - Phone:707-363-5525
Mailing Address - Fax:
Practice Address - Street 1:81 MARION LN
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-6666
Practice Address - Country:US
Practice Address - Phone:707-363-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.009884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered