Provider Demographics
NPI:1154338895
Name:KECALA, ZENON LEO (MD)
Entity type:Individual
Prefix:
First Name:ZENON
Middle Name:LEO
Last Name:KECALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZENON
Other - Middle Name:LEO
Other - Last Name:KECALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:533 W NORTH AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2135
Mailing Address - Country:US
Mailing Address - Phone:630-279-3222
Mailing Address - Fax:630-279-3230
Practice Address - Street 1:533 W NORTH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2135
Practice Address - Country:US
Practice Address - Phone:630-279-3222
Practice Address - Fax:630-279-3230
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45913Medicare UPIN
IL718142Medicare ID - Type Unspecified