Healthcare Provider Details

I. General information

NPI: 1548231699
Provider Name (Legal Business Name): ROBERT STEVEN KETAI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31390 NORTHWESTERN HWY SUITE E
FARMINGTON HILLS MI
48334-2561
US

IV. Provider business mailing address

31390 NORTHWESTERN HWY SUITE E
FARMINGTON HILLS MI
48334-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-2220
  • Fax: 248-855-1068
Mailing address:
  • Phone: 248-855-2220
  • Fax: 248-855-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberRK000588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: