Provider Demographics
NPI:1134948300
Name:KECK, ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KECK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 S TRENTON DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2433
Mailing Address - Country:US
Mailing Address - Phone:734-837-9111
Mailing Address - Fax:
Practice Address - Street 1:2805 S TRENTON DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2433
Practice Address - Country:US
Practice Address - Phone:734-837-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered