Provider Demographics
NPI:1043522584
Name:KETTIG, ERNEST JOHN
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:JOHN
Last Name:KETTIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 TAYLORSVILLE RD.
Mailing Address - Street 2:STE. A
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071
Mailing Address - Country:US
Mailing Address - Phone:502-354-9400
Mailing Address - Fax:502-354-9401
Practice Address - Street 1:206 TAYLORSVILLE RD.
Practice Address - Street 2:STE. A
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071
Practice Address - Country:US
Practice Address - Phone:502-354-9400
Practice Address - Fax:502-354-9401
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies