Individual
KEVIN L KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
481 E DIVISION ST, FOND DU LAC, WI 54935-3748
(920) 921-5676
(920) 921-2684
Mailing address
481 E DIVISION ST, FOND DU LAC, WI 54935-3748
(920) 921-5676
(920) 921-2684
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
38030
WI
Other
Enumeration date
02/07/2006
Last updated
01/05/2009
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