Individual
DR. PAUL A KETTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
559 CAPITOL BLVD, SAINT PAUL, MN 55103-2101
(651) 326-2400
(651) 326-2440
Mailing address
201 E NICOLLET BLVD, BURNSVILLE, MN 55337-1321
(952) 892-2117
(952) 892-2268
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38222
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400483
MEDICA
MN
05
—
042717900
—
MN
01
—
08F53KE
BCBS OF MN
MN
01
—
1008503
PREFERRED ONE
MN
01
—
111163
UCARE
MN
01
—
21983
AMERICA'S PPO
MN
01
—
4648605
AETNA
MN
01
—
HP17709
HEALTHPARTNERS
MN
Enumeration date
04/19/2006
Last updated
05/10/2019
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