Ketterling, Kevan E

Ketterling, Kevan E is an individual health care provider with primary practice located at 2525 Kaneville Rd , Geneva IL 60134-2578. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Ketterling, Kevan E can be contacted via phone (630) 584-1400.

Contact Information

Primary practice address
2525 Kaneville Rd Geneva IL 60134-2578
Phone: (630) 584-1400
Fax: (630) 584-1733
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 36082353 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 036082353 Illinois

Profile Details

NPI number 1770563710
LBN Legal business name Ketterling, Kevan E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2006
Last updated Feb 5th, 2013 - about 11 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 1770563710 NPPES
Illinois Other 141081 MEDICARE FACILITY
Illinois Other CF2064 MEDICARE FACILITY
Illinois Other 200007873 MEDICARE FACILITY
Illinois MEDICAID 036082353 MEDICARE FACILITY

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