Healthcare Provider Details

I. General information

NPI: 1407340847
Provider Name (Legal Business Name): SCOTT WILLIAM KETCHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BRIARWOOD CIR
ANN ARBOR MI
48108-1605
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 888-287-1082
  • Fax:
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301511027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: