Individual
KESHAWN GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
1248 BERRY LN, FLOSSMOOR, IL 60422
(708) 215-1604
Mailing address
1248 BERRY LN, FLOSSMOOR, IL 60422-1410
(708) 215-1604
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
157289
IL
Other
Enumeration date
03/04/2015
Last updated
07/25/2018
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