Healthcare Provider Details

I. General information

NPI: 1619688546
Provider Name (Legal Business Name): ZACHARY JAMES KEHOE RDN, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E HILLCREST DR APT 3104
DEKALB IL
60115-2449
US

IV. Provider business mailing address

220 E HILLCREST DR APT 3104
DEKALB IL
60115-2449
US

V. Phone/Fax

Practice location:
  • Phone: 630-842-7347
  • Fax:
Mailing address:
  • Phone: 630-842-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164008701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: