Individual
MR. KEITH PAUL CARIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2905 RYDAL ST, NEW LENOX, IL 60451-2734
(815) 485-6936
Mailing address
2905 RYDAL ST, NEW LENOX, IL 60451-2734
(815) 485-6936
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932109
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/26/2007
Last updated
07/08/2007
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