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Individual

DR. LAWRENCE G KETTWICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2825 STOCKYARD RD STE I-200, MISSOULA, MT 59808-1548
(406) 728-8420
Mailing address
2825 STOCKYARD RD, BLDG I-200, MISSOULA, MT 59808
(406) 728-8420
(406) 541-8430

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD2016-0071
NM
207L00000X
Anesthesiology Physician
Primary
MED-PHYS-LIC-55728
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MED-PHYS-LIC-55728
MONTANA MEDICAL LICENSE
MT
Enumeration date
05/03/2012
Last updated
07/21/2022
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