Provider Demographics
NPI:1437946688
Name:OVERHISER, ANTHONY D (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:OVERHISER
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N FREMONT ST APT 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2576
Mailing Address - Country:US
Mailing Address - Phone:815-603-8855
Mailing Address - Fax:815-603-8855
Practice Address - Street 1:1515 N FREMONT ST APT 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2576
Practice Address - Country:US
Practice Address - Phone:815-603-8855
Practice Address - Fax:815-603-8855
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.010826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered