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Individual
LIA R KETTENIS
Active
Individual
LIA R KETTENIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01063824A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01063824A
IN
Other
Enumeration date
05/21/2007
Last updated
03/05/2024
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