Active NPI
Michele C Schifferdecker, DIETICIAN
- Registered Dietitian
- Centreville, IL
National Provider Identifier
1508173907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164002761
- Practice address
- 5900 Bond Ave
Centreville, IL 62207-2326 - Phone
- (618) 332-5212
- NPI assigned
- Sep 7, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164002761 | IL | Primary |
Addresses
Primary practice location
5900 Bond Ave
Centreville, IL 62207-2326
Mailing address
1836 Lackland Hill Pkwy
Attn Credentialing Department
Saint Louis, MO 63146-3572
Phone (314) 872-1308
Other names 1
- Michele C Mueth
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164002761 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283817600000",
"number": "1508173907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 LACKLAND HILL PKWY",
"address_2": "ATTN CREDENTIALING DEPARTMENT",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463572",
"telephone_number": "314-872-1308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 BOND AVE",
"city": "CENTREVILLE",
"state": "IL",
"postal_code": "622072326",
"telephone_number": "618-332-5212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHIFFERDECKER",
"first_name": "MICHELE",
"middle_name": "C",
"credential": "DIETICIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-07",
"last_updated": "2010-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164002761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELE",
"last_name": "MUETH",
"middle_name": "C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Centreville, IL
- Christina M Ochoa, LCPC
- Natasha Renee Patterson, LPC
- Megan Lynette Preville, DMD
- Susan Thoma Rauckman, ANP-BC
- Readynow Transit, LLC
- Bhawna Sharma, M.D
- Southern Illinois Healthcare Foundation Inc (SIHF Healthcare)
- Southern Illinois Healthcare Foundation Inc (Centreville Health Center)
- Southern Illinois Healthcare Foundation, Inc (Touchette Health Center)
- Southern Illinois Healthcare Foundation, Inc. (SIHF Healthcare)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.