Individual
KEN DIZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
660 N WESTMORELAND RD, LAKE FOREST, IL 60045-1659
(847) 234-5600
Mailing address
380 ROCK HALL CIR, GRAYSLAKE, IL 60030-1102
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041382652
IL
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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