Provider Demographics
NPI:1528227220
Name:KETTUNEN, LEEANN MCALILEY (MD)
Entity Type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:MCALILEY
Last Name:KETTUNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:101 E BRUNSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2526
Mailing Address - Country:US
Mailing Address - Phone:334-393-3686
Mailing Address - Fax:334-347-4906
Practice Address - Street 1:101 E BRUNSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2526
Practice Address - Country:US
Practice Address - Phone:334-393-3686
Practice Address - Fax:334-347-4906
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.32690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine