Individual
MARK W. KETTERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
6301007377
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MK007377
CHAMPUS-CHAMPUS
—
05
—
PHD888810
—
MI
Enumeration date
01/08/2007
Last updated
07/08/2007
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