Doctor Name: | ANDREW JOHN KETNER |
NPI Number: | 1043574874 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 5101019855 |
Business Practice Address: | 50 N Perry St Pontiac, MI - 483422217 |
Business Phone Number: | 2483385392 |
Business Fax Number: | 2483385567 |
Mailing Address: | 50 N Perry St, PONTIAC |
State: | MI |
Postal Code: | 483422217 |
Phone Number: | 2483385392 |
Fax Number: | 2483385567 |
NPI Enumeration Date: | 06/26/2012 |
NPI Last Update Date: | 06/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5101019855 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |