MEDICARE: COLLEEN MARIE KESTEL MBA, RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	164.007711	IL

General Provider Information

NPI Number	:	1881337129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MARIE KESTEL MBA, RDN, LDN

Provider Business Mailing Address
First Line	:	14850 W DELANEY RD
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-9660
Country	:	US
Telephone Number	:	708-609-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2081 CALISTOGA DR STE 2N
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-4833
Country	:	US
Telephone Number	:	815-320-2410
Fax Number	:	815-425-7123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	07/17/2023

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