Healthcare Provider Details

I. General information

NPI: 1154555977
Provider Name (Legal Business Name): KECALA & KECALA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W NORTH AVE STE 206
ELMHURST IL
60126-2135
US

IV. Provider business mailing address

533 W NORTH AVE STE 206
ELMHURST IL
60126-2135
US

V. Phone/Fax

Practice location:
  • Phone: 630-279-3222
  • Fax: 630-279-3230
Mailing address:
  • Phone: 630-279-3222
  • Fax: 630-279-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036067696
License Number StateIL

VIII. Authorized Official

Name: DR. ZENON L KECALA
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 630-279-3222