Individual
DR. KEVAN E KETTERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 KANEVILLE RD, GENEVA, IL 60134-2578
(630) 584-1400
(630) 584-1733
Mailing address
2525 KANEVILLE RD, GENEVA, IL 60134-2578
(630) 584-1400
(630) 584-1733
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
36082353
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036082353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082353
—
IL
01
—
141081
MEDICARE FACILITY
IL
01
—
200007873
RAILROAD MEDICARE
IL
01
—
CF2064
RAILROAD GROUP
IL
Enumeration date
01/17/2006
Last updated
02/05/2013
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