Individual
DR. MICHELE A KETTLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12200 PRESTON RD, DALLAS, TX 75230-2223
(972) 560-2667
Mailing address
12200 PRESTON RD, DALLAS, TX 75230-2223
(972) 560-2667
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
K6624
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85285G
BLUE CROSS
TX
Enumeration date
12/05/2006
Last updated
07/08/2007
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