Individual
JOHN MARSHALL KETNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5624 HIGHLAND RD, WATERFORD, MI 48327-1926
(248) 674-9664
(248) 674-5409
Mailing address
5624 HIGHLAND RD, WATERFORD, MI 48327-1926
(248) 674-9664
(248) 674-5409
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
JK007570
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107304
CARE CHOICES
MI
05
—
2125962
—
MI
01
—
2856
CAPE ID
MI
01
—
4621708005
CIGNA ID
MI
01
—
5630206
BLUE CROSS BLUE SHIELD ID
MI
01
—
E26093
HEALTH ALLIANCE PLAN ID
MI
Enumeration date
06/02/2006
Last updated
06/24/2010
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