Individual
DONALD LEE KETTWICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 ENCINO PL NE, SUITE E, ALBUQUERQUE, NM 87102-2619
(505) 245-5737
(505) 245-5739
Mailing address
711 ENCINO PL NE, SUITE E, ALBUQUERQUE, NM 87102-2619
(505) 245-5737
(505) 245-5739
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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