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Organization
INTERVENTIONAL PAIN CENTER, PLLC.
Active
Organization
INTERVENTIONAL PAIN CENTER, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID K KETROSER M.D. (OWNER)
(952) 236-7610
Entity
Organization
Contact information
Practice address
10653 WAYZATA BLVD, SUITE 200, MINNETONKA, MN 55305-1528
(952) 236-7610
(952) 426-0674
Mailing address
10653 WAYZATA BLVD, SUITE 200, MINNETONKA, MN 55305-1528
(952) 236-7610
(952) 426-0674
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3852
MN
207X00000X
Orthopaedic Surgery Physician
34220
MN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
44760
MN
2084N0400X
Neurology Physician
24316
MN
208VP0014X
Interventional Pain Medicine Physician
42871
MN
Other
Enumeration date
07/26/2013
Last updated
06/17/2014
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