Provider Demographics
NPI:1649398280
Name:KECK, BARBARA (DN)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:KECK
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2125
Mailing Address - Country:US
Mailing Address - Phone:708-308-8314
Mailing Address - Fax:708-485-7003
Practice Address - Street 1:3504 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1302
Practice Address - Country:US
Practice Address - Phone:708-308-8314
Practice Address - Fax:708-485-7003
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
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635344OtherBCBS OF ILLINOIS