Individual
BEVERLEY L KETEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 E PENNSYLVANIA AVE, SUITE 212, PEORIA, IL 61603-3089
(309) 676-8123
(309) 676-8455
Mailing address
200 E PENNSYLVANIA AVE, SUITE 212, PEORIA, IL 61603-3089
(309) 676-8123
(309) 676-8455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036051866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020051363
BCBS
IL
05
—
036051866
—
IL
Enumeration date
03/08/2007
Last updated
12/11/2008
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