Doctor Name: | DR. MILORAD P. KETCHENS |
NPI Number: | 1942328166 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 1109 S Lincoln Ave Urbana, IL - 618014703 |
Business Phone Number: | 2173332700 |
Business Fax Number: | |
Mailing Address: | Po Box 143, URBANA |
State: | IL |
Postal Code: | 618030143 |
Phone Number: | 2173448190 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |