Ketterer, Mark W.

Ketterer, Mark W. is an individual health care provider with primary practice located at Henry Ford Health System 2799 West Grand Boulevard, Detroit MI 48202. He recently has only one registered license in Allopathic & Osteopathic Physicians / Clinical Neurophysiology, which is considered as his primary health care specialty. Ketterer, Mark W. can be contacted via phone (313) 916-2436.

Contact Information

Primary practice address
Henry Ford Health System 2799 West Grand Boulevard Detroit MI 48202
Phone: (313) 916-2436
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Clinical Neurophysiology 2084N0600X 6301007377 Michigan

Profile Details

NPI number 1285782870
LBN Legal business name Ketterer, Mark W.
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 8th, 2007
Last updated Jul 8th, 2007 - about 18 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 1285782870 NPPES
Other MK007377 CHAMPUS-CHAMPUS
Other MK007377 CHAMPUS-CHAMPUS
MEDICAID PHD888810 CHAMPUS-CHAMPUS

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