Individual provider Active NPI

Taibat Lawal

  • Registered Dietitian
  • Chicago, IL
National Provider Identifier
1740723386
Registry record updated Oct 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164006999 Issued in IL
Practice address
1801 W Taylor St
Chicago, IL 60612-4795
Phone
(312) 413-3631
NPI assigned
Nov 30, 2016
Last updated
Oct 31, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164006999 IL Primary
Metabolic Nutrition Registered Dietitian 133VN1006X 164006999 IL

Addresses

Primary practice location

1801 W Taylor St
Chicago, IL 60612-4795

Mailing address

1801 W Taylor St
Chicago, IL 60612-4795

Other practice location 1

19767 Torrence Ave
Lynwood, IL 60411-7624
Phone (708) 596-5177

Other practice location 2

7250 S Dorchester Ave
Chicago, IL 60619-1543
Phone (312) 550-4635

Other identifiers 1

IdentifierTypeStateIssuer
164006999MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170113000928 IL Practitioner - Registered Dietitian Or Nutrition Professional 9638451305 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
164006999ILMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Aug 21, 2025 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Aug 21, 2025 Accepting new patients

Locations

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1740723386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-413-3631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19767 Torrence Ave",
            "address_purpose": "LOCATION",
            "city": "Lynwood",
            "state": "IL",
            "postal_code": "604117624",
            "country_code": "US",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7250 S Dorchester Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606191543",
            "country_code": "US",
            "telephone_number": "312-550-4635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAWAL",
        "first_name": "TAIBAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-30",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164006999",
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "IL",
            "license": "164006999",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164006999",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.