MARK W. KETTERER (NPI# 1285782870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285782870 |
| Entity Type | Individual |
| Full Name | MARK W. KETTERER |
| Credential | PH.D. |
| Practice Address |
Henry Ford Health System 2799 West Grand Boulevard Detroit MI 48202 |
| Practice Telephone | 3139162436 |
| Mailing Telephone | 3139162436 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
6301007377 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CHAMPUS-CHAMPUS | MK007377 | 01 | |
| COMMERCIAL-COMMERCIAL NUMBER | MK007377 | 01 | |
| MI | PHD888810 | 05 |
| Street Address |
HENRY FORD HEALTH SYSTEM 2799 WEST GRAND BOULEVARD |
| City | DETROIT |
| State | MI |
| Zip Code | 48202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336147461 | Joseph Lawrence Lelli | Surgery | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2005-07-12 |
| 1053794859 | Ali Malik | Podiatrist | Henry Ford Health System, 1 Ford Pl Ste 2e, Detroit, MI 48202 | 2015-06-30 |
| 1730389198 | Folusho Everton Ogunfiditimi | Physician Assistant | Henry Ford Health System, 2799 West Grand Blvd., Detroit, MI 48202 | 2007-07-23 |
| 1598897696 | Geoffrey S. Mwaungulu | Internal Medicine | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-03-12 |
| 1578606463 | Rebecca S. Lurcott | Ophthalmology | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-02-14 |
| 1184767949 | Jan Rival | Internal Medicine | Henry Ford Health System, 3031 West Grand Blvd., Detroit, MI 48202 | 2007-02-14 |
| 1295875342 | Vinaya Vallabhaneni | Preventive Medicine | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-02-07 |
| 1699821157 | Morton B. Cash | Radiology | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-01-26 |
| 1881748242 | Felix Umansky | Neurological Surgery | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-01-23 |
| 1558415901 | Sidney Goldstein | Internal Medicine | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-01-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609238674 | Satyamurthy Kotamraju Md PC | Psychiatry & Neurology | 11457 Shoemaker St, Detroit, MI 48213-3418 | 2016-03-28 |
| 1578941225 | Jian Xu | Psychiatry & Neurology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2015-05-14 |
| 1942555727 | Tammam Dayyoub | Psychiatry & Neurology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2012-07-18 |
| 1922242635 | Sadia Najamuddin | Psychiatry & Neurology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2009-04-24 |
| 1841454816 | Neena Jamwal | Psychiatry & Neurology | 4646 John R St, Department of Neurology, Detroit, MI 48201-1916 | 2008-07-17 |
| 1477758712 | Vibhangini Sanjay Wasade | Psychiatry & Neurology | 2799 W. Grand Blvd, Henry Ford Hospital, Detroit, MI 48202-2608 | 2007-06-18 |
| 1083626501 | Satyamurthy Kotamraju | Psychiatry & Neurology | 11457 Shoemaker St, Detroit, MI 48213-3418 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598016149 | Ivo Drury | Psychiatry & Neurology | 2070 Hollow Oak Dr, Ann Arbor, MI 48103-8402 | 2012-09-23 |
| 1396071684 | Michigan Spinal Rehabilitation Clinics Pllc | Psychiatry & Neurology | 2401 W. Genesee Street, Suite A, Lapeer, MI 48446 | 2009-10-22 |
| 1265478671 | Karim Mousa Fram | Psychiatry & Neurology | 237 Davis Lake Rd, Suite B, Lapeer, MI 48446-1466 | 2006-06-22 |
| 1174597991 | Carey M Vigor Md PC | Psychiatry & Neurology | 2725 Packard Rd, # 101, Ann Arbor, MI 48108-3443 | 2006-02-16 |
| 1144855131 | Hasan & Hasan Neurology Group PC | Psychiatry & Neurology | 237 Davis Lake Rd Ste D, Lapeer, MI 48446-1485 | 2020-03-10 |
| 1053849810 | Hien Luu | Psychiatry & Neurology | 2750 E Beltline Ave Ne, Grand Rapids, MI 49525-8614 | 2017-05-24 |
| 1417193087 | Mohammad Javad Poostizadeh | Psychiatry & Neurology | 245 Cherry St Se, Ste 104, Grand Rapids, MI 49503 | 2009-01-01 |
| 1982865648 | Anderon Neuordiagnotstics PC | Psychiatry & Neurology | 1135 W University Dr, Suite 410, Rochester, MI 48307-1871 | 2008-06-24 |
| 1477710135 | Elctrodiagnostic Medicine Consultants, Pllc | Psychiatry & Neurology | 1515 Lake Lansing Rd, Suite F-1, Lansing, MI 48912-3753 | 2008-05-20 |
| 1942487053 | Mercy Memorial Hospital Corporation | Psychiatry & Neurology | 718 N Macomb St, Monroe, MI 48162-7815 | 2008-01-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.