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General NPI Number Information
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NPI Number | 1295870582
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Entity Type | Organization
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Legal Business Name | DRS KETAI P C
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 31390 NORTHWESTERN HWY SUITE E
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2561
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Country | US
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Telephone | 248-855-2220
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Fax | 248-855-1068
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Provider Business Mailing Address
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Address Line | 31390 NORTHWESTERN HWY SUITE E
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2561
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Country | US
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Telephone | 248-855-2220
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Fax | 248-855-1068
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT STEVEN KETAI
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Credential | D.P.M.
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Telephone | 248-855-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | RK000588
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License Number State | MI
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