Ketel, Beverley L

Ketel, Beverley L is an individual health care provider with primary practice located at 200 E Pennsylvania Ave Suite 212, Peoria IL 61603-3089. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Ketel, Beverley L can be contacted via phone (309) 676-8123.

Contact Information

Primary practice address
200 E Pennsylvania Ave Suite 212 Peoria IL 61603-3089
Phone: (309) 676-8123
Fax: (309) 676-8455
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036051866 Illinois

Profile Details

NPI number 1659402048
LBN Legal business name Ketel, Beverley L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2007
Last updated Dec 11th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659402048 NPPES
Illinois MEDICAID 036051866
Illinois Other 020051363
Illinois Other 020051363

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