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NPI Code Detail

MEDICARE: IVAN C KETTER MD

MEDICARE: IVAN C KETTER 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
1207Q00000XFamily Medicine Physician422467KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194724500
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN C KETTER MD
Provider Business Mailing Address
First Line : PO BOX 1657
Second Line :
City : TOPEKA
State : KS
Zip : 66601-1657
Country : US
Telephone Number : 785-295-8108
Fax Number : 785-231-5991
Provider Business Practice Location Address
First Line : 2835 SW MISSION WOODS DR
Second Line :
City : TOPEKA
State : KS
Zip : 66614-5616
Country : US
Telephone Number : 785-271-1818
Fax Number : 785-232-0739
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 03/04/2011

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1962447813 — JENNIFER REBECCA HARADER MD
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Directions to “ IVAN C KETTER MD” Practice Location

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