Kettyle, William Millen

Kettyle, William Millen is an individual health care provider with primary practice located at 77 Mass Avenue Medical E23, Cambridge MA 02139. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Kettyle, William Millen can be contacted via phone (617) 253-4487.

Contact Information

Primary practice address
77 Mass Avenue Medical E23 Cambridge MA 02139
Phone: (617) 253-4487
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 35673 Massachusetts
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 35673 Massachusetts
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 35673 Massachusetts

Profile Details

NPI number 1306823414
LBN Legal business name Kettyle, William Millen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Apr 5th, 2012 - about 13 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 1306823414 NPPES
Massachusetts MEDICAID 2041588
Massachusetts Other J17018
Massachusetts Other 705990

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