Organization
DONALD E HUNNESHAGEN M D INC & MICHAEL KETELAAR M D PTR HUNNESHAGEN DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TIMOTHY KETELAAR M D (PARTNER)
(209) 368-7121
Entity
Organization
Contact information
Practice address
1231 W VINE ST, SUITE 19, LODI, CA 95240-5109
(209) 368-7121
(209) 368-5750
Mailing address
1231 W VINE ST, SUITE 19, LODI, CA 95240-5109
(209) 368-7121
(209) 368-5750
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487705935
NPI
CA
Enumeration date
02/12/2007
Last updated
06/17/2009
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