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NPI Code Detail

MEDICARE: DR. JEFFREY K KETCHAM MD

MEDICARE: DR. JEFFREY K KETCHAM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician0360743479IL
2207LP2900XPain Medicine (Anesthesiology) Physician0360743479IL
3207Q00000XFamily Medicine Physician0360743479IL

General Provider Information

NPI Number : 1245229368
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY K KETCHAM MD
Provider Business Mailing Address
First Line : 8600 N STATE ROUTE 91
Second Line : SUITE 250
City : PEORIA
State : IL
Zip : 61615-9541
Country : US
Telephone Number : 309-692-5393
Fax Number : 309-692-2583
Provider Business Practice Location Address
First Line : 8600 N STATE ROUTE 91
Second Line : SUITE 250
City : PEORIA
State : IL
Zip : 61615-9541
Country : US
Telephone Number : 309-692-5393
Fax Number : 309-692-2583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 09/11/2025

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