Cheryl Ketelsen (NPI# 1770938532, PAC ID# 0143512632) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1770938532 |
| PAC ID by PECOS | 0143512632 |
| Professional Enrollment ID | I20160630002385 |
| Full Name | Cheryl Ketelsen |
| Organization Legal Name | SAN LUIS DERMATOLOGY AND LASER CLINIC INC |
| Address |
1551 Bishop St Suite 410 San Luis Obispo CA 93401-4663 |
| Phone Number | 8055412650 |
| Gender | F |
| Graduation Year | 2015 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 5496700767 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050107 | MARIAN REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 15 Santa Rosa St, San Luis Obispo, CA 93405-1811 | 8055412650 | SAN LUIS DERMATOLOGY AND LASER CLINIC INC |
| 1551 Bishop St, Suite 410, San Luis Obispo, CA 93401-4663 | 8055412650 | SAN LUIS DERMATOLOGY AND LASER CLINIC INC |
| Organization Legal Name | SAN LUIS DERMATOLOGY AND LASER CLINIC INC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Charles B Fishman | Dermatology | San Luis Dermatology and Laser Clinic Inc | 15 Santa Rosa St, San Luis Obispo, CA 93405-1811 |
| Robert Jeffrey Herten | Dermatology | San Luis Dermatology and Laser Clinic Inc | 15 Santa Rosa St, San Luis Obispo, CA 93405-1811 |
| Joseph W Diehl | Dermatology | San Luis Dermatology and Laser Clinic Inc | 15 Santa Rosa St, San Luis Obispo, CA 93405-1811 |
| Michael P Heffernan | Dermatology | San Luis Dermatology and Laser Clinic Inc | 15 Santa Rosa St, San Luis Obispo, CA 93405-1811 |
| Street Address |
1551 BISHOP ST SUITE 410 |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip | 93401-4663 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leslie Joslin | Nurse Practitioner | Chris M Byrne Dpm Inc | 1551 Bishop St, 210b, San Luis Obispo, CA 93401-4635 |
| Joel Correa | Chiropractic | Community Health Centers of The Central Coast, Inc. | 1551 Bishop St, Suite A160, San Luis Obispo, CA 93401-4636 |
| Carianne N Crowe | Physician Assistant | Daniel C Zovich Md Inc | 1551 Bishop St, D450, San Luis Obispo, CA 93401-4635 |
| Julia Elizabeth Davison | Physician Assistant | Pacific Psychiatry Inc., A Professional Medical Corporation | 1551 Bishop St, Suite A 150, San Luis Obispo, CA 93401-4635 |
| Gary D Mulder | Podiatry | Chris M Byrne Dpm Inc | 1551 Bishop St, 210b, San Luis Obispo, CA 93401-4635 |
| Paul D Wetzel | Gastroenterology | Central Coast Gastroenterology Medical Group | 1551 Bishop St, San Luis Obispo, CA 93401-4661 |
| Kelli M Rose | Allergy/immunology | Allergy Partners of California, Inc | 1551 Bishop St, Suite 520, San Luis Obispo, CA 93401-4665 |
| Daniel Zovich | Gastroenterology | Daniel C Zovich Md Inc | 1551 Bishop St, D450, San Luis Obispo, CA 93401-4635 |
| Joseph C Pon | Chiropractic | Community Health Centers of The Central Coast, Inc. | 1551 Bishop St, Suite A160, San Luis Obispo, CA 93401-4636 |
| Jeffrey B Mundorf | Gastroenterology | Central Coast Gastroenterology Medical Group | 1551 Bishop St, San Luis Obispo, CA 93401-4661 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Patrick J Spalding | Obstetrics/gynecology | 1551 Bishop Medical Plz, C310, San Luis Obispo, CA 93401 | |
| Nell Bennett | Clinical Social Worker | 956 Walnut St, Suite 200, San Luis Obispo, CA 93401-1707 | |
| Jeffrey Friedman | Psychologist, Clinical | 956 Walnut St, Suite 200, San Luis Obispo, CA 93401-1707 | |
| Kourosh Bagheri | Internal Medicine | 1177 Marsh St, Suite 100, San Luis Obispo, CA 93401-2316 | |
| Donald A Ramberg | Neurosurgery | 699 California Blvd, Suite B, San Luis Obispo, CA 93401-2507 | |
| Phillip Kissel | Neurosurgery | 699 California Blvd, Suite A, San Luis Obispo, CA 93401-2507 | |
| Steven C Johnson | Ophthalmology | 628 California Blvd, Suite C, San Luis Obispo, CA 93401-2547 | |
| Laura A Lubarsky | Pulmonary Disease | Central Coast Chest Consultants, A Medical Corporation | 1428 Phillips Ln, Suite 203, San Luis Obispo, CA 93401-2551 |
| David C Anderson | Physician Assistant | Central Coast Chest Consultants, A Medical Corporation | 1428 Phillips Ln, San Luis Obispo, CA 93401-2551 |
| Michael James Ryan | Pulmonary Disease | Central Coast Chest Consultants, A Medical Corporation | 1428 Phillips Ln, Suite 203, San Luis Obispo, CA 93401-2551 |
| Find all physicians in zip 93401 | |||
| City | SAN LUIS OBISPO |
| Zip Code | 93401 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SAN LUIS OBISPO + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Cheryl Ketelsen.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.