Individual
DONALD LEE KETTWICH
Active
Individual
DONALD LEE KETTWICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
76-208
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00015941
—
NM
01
—
00NM019E05
BLUE CROSS-BLUE SHIELD-NM
NM
01
—
201005185
PRESBYTERIAN HEALTH PLAN
NM
01
—
85-0284119
JOHN ALDEN
NM
Enumeration date
01/15/2007
Last updated
05/23/2008
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