Healthcare Provider Details

I. General information

NPI: 1477177251
Provider Name (Legal Business Name): STEVEN MENEGUS RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 FYRE LAKE DR
SHERRARD IL
61281-9349
US

IV. Provider business mailing address

1317 FYRE LAKE DR
SHERRARD IL
61281-9349
US

V. Phone/Fax

Practice location:
  • Phone: 925-899-8450
  • Fax:
Mailing address:
  • Phone: 925-899-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86112841
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: