MEDICARE: DRS KETAI P C

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	213E00000X	Podiatrist	RK000588	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F3632384812	OTHER	MI	MEDICARE PPI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	80721	OTHER	MI	OMNICARE POS
3	P76006	OTHER	MI	BCN
4	540F340180	OTHER	MI	BCBSM DME
5	5635300	OTHER	MI	BLUE CROSSBLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	20721	OTHER	MI	OMNICARE HMO

General Provider Information

NPI Number	:	1295870582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS KETAI P C

Provider Business Mailing Address
First Line	:	31390 NORTHWESTERN HWY
Second Line	:	SUITE E
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2561
Country	:	US
Telephone Number	:	248-855-2220
Fax Number	:	248-855-1068

Provider Business Practice Location Address
First Line	:	31390 NORTHWESTERN HWY
Second Line	:	SUITE E
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2561
Country	:	US
Telephone Number	:	248-855-2220
Fax Number	:	248-855-1068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT STEVEN KETAI
Credential	:	D.P.M.
Telephone Number	:	248-855-2220

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/26/2009

Similar Medicare Providers

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Practice Location Address:

31390 NORTHWESTERN HWY , SUITE E
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48334-2561

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1942388491 — DR. LINDA DARIAN DDS
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1043386733 — DR. DANIEL BRUCE COHEN D.C.
Practice Location Address:

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48334-2561

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1366590036 — DR. ROBERT WARREN LEVINE D.C.
Practice Location Address:

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1154441228 — LEVINE CHIROPRACTIC OF FARMINGTON HILLS P.C.
Practice Location Address:

31390 NORTHWESTERN HWY , SUITE C.
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48334-2561

Practice Phone: 248-855-2666
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Directions to “DRS KETAI P C ” Practice Location

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