Healthcare Provider Details

I. General information

NPI: 1134191471
Provider Name (Legal Business Name): KARI MICHELLE KETVERTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S MAIN ST
HURON OH
44839
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-6117
  • Fax: 419-433-7226
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-086419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: