MEDICARE: ROBERT STEVEN KETAI D.P.M.

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
1	213E00000X	Podiatrist	RK000588	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	0F3632384812	OTHER	MI	MEDICARE (PPI)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80721	OTHER	MI	OMNICARE (POS)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P76006	OTHER	MI	BLUE CARE NETWORK
5	20721	OTHER	MI	OMNICARE (HMO)
6	5635300	OTHER	MI	BLUE CROSS/BLUE SHIELD MI
7	540F340180	OTHER	MI	BCBSM DME
8	RK000588	OTHER	MI	LICENSE NUMBER

General Provider Information

NPI Number	:	1548231699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT STEVEN KETAI D.P.M.

Provider Business Mailing Address
First Line	:	31390 NORTHWESTERN HWY
Second Line	:	SUITE E
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2561
Country	:	US
Telephone Number	:	248-855-2220
Fax Number	:	248-855-1068

Provider Business Practice Location Address
First Line	:	31390 NORTHWESTERN HWY
Second Line	:	SUITE E
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2561
Country	:	US
Telephone Number	:	248-855-2220
Fax Number	:	248-855-1068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/24/2008

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