Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 48933 | MN |
N | 207RH0000X | Hematologist | 49571-20 | WI |
N | 207RX0202X | Medical Oncology | 48933 | MN |
N | 207RX0202X | Medical Oncology | 49571-20 | WI |
NPI | 1164465191 |
---|---|
Provider Name | Lloyd Howard Ketchum |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 12/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34880100 | (05) | WI |
985908000 | (05) | MN |