Mark W. Ketterer
Clinical Neurophysiologist
Henry Ford Health System 2799 West Grand Boulevard
Detroit
, Michigan 48202
Mark W. Ketterer
Clinical Neurophysiologist
Henry Ford Health System 2799 West Grand Boulevard
Detroit
, Michigan 48202
(313) 916-2436
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About
Features
Specialties
- Clinical Neurophysiologist
Languages spoken
- English
Location
First Address
- Mark W. Ketterer
- Henry Ford Health System 2799 West Grand Boulevard
- Detroit, MI
- Zip : 48202
- Phone : (313) 916-2436
Second Address
- Mark W. Ketterer
- Henry Ford Health System 2799 West Grand Boulevard
- Detroit, MI
- Zip : 48202
- Phone : (313) 916-2436
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2084N0600X | Clinical Neurophysiologist | 6301007377 | MI |
National Provider Identifier
| NPI | 1285782870 |
|---|---|
| Provider Name | Mark W. Ketterer |
| First Address | Detroit, MI 48202 |
| Second Address | Detroit, MI 48202 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/01/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| MK007377 | CHAMPUS-CHAMPUS (01) | |
| MK007377 | COMMERCIAL-COMMERCIAL NUMBER (01) | |
| PHD888810 | (05) | MI |
| R90612 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.