Individual
DR. KENNETH E. ETTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
206 MAIN ST. E., HINCKLEY, MN 55037
(320) 384-6618
(320) 384-6635
Mailing address
4570 CTY. HWY. 61, MOOSE LAKE, MN 55767
(218) 485-4491
(218) 485-4724
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23035
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595790700
—
MN
Enumeration date
05/27/2005
Last updated
12/04/2012
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