MEDICARE: KARI MICHELLE KETVERTIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-086419	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00639734	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134191471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI MICHELLE KETVERTIS MD

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-609-1112
Fax Number	:	419-609-1123

Provider Business Practice Location Address
First Line	:	808 S MAIN ST
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839
Country	:	US
Telephone Number	:	419-433-6117
Fax Number	:	419-433-7226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	04/22/2013

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Directions to “ KARI MICHELLE KETVERTIS MD” Practice Location

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