Provider Demographics
NPI:1740233873
Name:VETTEL, KENNETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:VETTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9802
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-9802
Mailing Address - Country:US
Mailing Address - Phone:308-381-0162
Mailing Address - Fax:308-389-4445
Practice Address - Street 1:3563 PRAIRIEVIEW ST STE 300
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4442
Practice Address - Country:US
Practice Address - Phone:308-381-0162
Practice Address - Fax:308-389-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE18243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEBV1888746OtherDEA
NE266774Medicare PIN
NEBV1888746OtherDEA