Individual
ALISHA L KETTERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
360 S MOUNTIN DR, MAYVILLE, WI 53050-1498
(920) 387-7500
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51141
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004518
—
WI
Enumeration date
06/07/2006
Last updated
12/29/2020
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