Ketelaar, Matthew A

Ketelaar, Matthew A is an individual health care provider with primary practice located at 1970 E 53Rd St , Davenport IA 52807-2710. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Ketelaar, Matthew A can be contacted via phone (563) 359-3949.

Contact Information

Primary practice address
1970 E 53Rd St Davenport IA 52807-2710
Phone: (563) 359-3949
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 28007 Iowa

Profile Details

NPI number 1336109180
LBN Legal business name Ketelaar, Matthew A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated May 5th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336109180 NPPES
Other 300034141 RR MDC RGPCSC
MEDICAID 5096792 RR MDC RGPCSC
MEDICAID 2096792 RR MDC RGPCSC
Other 300132302 RR MDC RGPCSC
Other 32281 RR MDC RGPCSC
Other 06050 RR MDC RGPCSC

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