Individual
DR. RICHARD T KETTELKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
202 10TH ST SE, SUITE 225, CEDAR RAPIDS, IA 52403-2404
(319) 364-7101
Mailing address
202 10TH ST SE, SUITE 225, CEDAR RAPIDS, IA 52403-2404
(319) 364-7101
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
3618
IA
207RI0011X
Interventional Cardiology Physician
Primary
3618
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922042894
—
IA
01
—
P00823157
RR MEDICARE
IA
Enumeration date
06/15/2006
Last updated
11/21/2018
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