Provider Demographics
NPI:1275774754
Name:KERFOOT, KAREN KERASOTES (MSOM, L AC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KERASOTES
Last Name:KERFOOT
Suffix:
Gender:F
Credentials:MSOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3263
Mailing Address - Country:US
Mailing Address - Phone:630-251-8565
Mailing Address - Fax:
Practice Address - Street 1:957 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3263
Practice Address - Country:US
Practice Address - Phone:630-251-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist