Healthcare Provider Details

I. General information

NPI: 1760441968
Provider Name (Legal Business Name): STEVEN KETCHEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 N CRAYCROFT RD STE 200
TUCSON AZ
85712-2254
US

IV. Provider business mailing address

1760 E RIVER RD 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-2409
  • Fax: 520-324-2454
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: