Provider Demographics
NPI:1003382748
Name:TOUMA, ALICE (RDN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:TOUMA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44645 DUNBARTON DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3919
Mailing Address - Country:US
Mailing Address - Phone:734-419-1225
Mailing Address - Fax:
Practice Address - Street 1:1525 W HOMER ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1285
Practice Address - Country:US
Practice Address - Phone:888-785-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI987172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered