Provider Demographics
NPI:1508984014
Name:CARIO, KEITH PAUL
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:PAUL
Last Name:CARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:JACKI
Other - Middle Name:LYN
Other - Last Name:CAIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2905 RYDAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2734
Mailing Address - Country:US
Mailing Address - Phone:815-485-6936
Mailing Address - Fax:
Practice Address - Street 1:2905 RYDAL ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2734
Practice Address - Country:US
Practice Address - Phone:815-485-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932109OtherBLUE CROSS BLUE SHIELD