Provider Demographics
NPI:1659368967
Name:KETTLER, ANNE H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:H
Last Name:KETTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:15101 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:KS
Practice Address - Zip Code:66223-3154
Practice Address - Country:US
Practice Address - Phone:913-681-8866
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0422213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5530037AMedicare ID - Type Unspecified
E54633Medicare UPIN