Individual
PAUL A KETTL
Active
Individual
PAUL A KETTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD036495E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010554330001
—
PA
05
—
0010554330003
—
PA
01
—
100774
VALUE OPTIONS
PA
01
—
427936
HIGHMARK BLUE SHIELD
PA
01
—
50048776
CAPITAL BLUE CROSS
PA
Enumeration date
10/28/2005
Last updated
08/19/2007
Update your record
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