Individual
MATTHEW A KETELAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Mailing address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28007
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06050
BCBS IA RGIC LLC
—
05
—
2096792
—
IA
01
—
300034141
RR MDC RGPCSC
—
01
—
300132302
RR MDC RGIC LLC
—
01
—
32281
BCBS IA RGPCSC
—
05
—
5096792
—
IA
Enumeration date
03/24/2006
Last updated
05/05/2021
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