Provider Demographics
NPI:1548231699
Name:KETAI, ROBERT STEVEN (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:KETAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31390 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2561
Mailing Address - Country:US
Mailing Address - Phone:248-855-2220
Mailing Address - Fax:248-855-1068
Practice Address - Street 1:31390 NORTHWESTERN HWY
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2561
Practice Address - Country:US
Practice Address - Phone:248-855-2220
Practice Address - Fax:248-855-1068
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK000588213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80721OtherOMNICARE (POS)
MI1018770Medicaid
MIP76006OtherBLUE CARE NETWORK
MI0F3632384812OtherMEDICARE (PPI)
MI20721OtherOMNICARE (HMO)
MI5635300OtherBLUE CROSS/BLUE SHIELD MI
MI540F340180OtherBCBSM DME
MIRK000588OtherLICENSE NUMBER
MI5635300OtherBLUE CROSS/BLUE SHIELD MI
MIRK000588OtherLICENSE NUMBER
MI20721OtherOMNICARE (HMO)