Provider Demographics
NPI:1962478388
Name:KETTY, ARPITHA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARPITHA
Middle Name:KUMAR
Last Name:KETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2620
Mailing Address - Fax:904-953-2613
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-953-2620
Practice Address - Fax:904-953-2613
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00662219OtherRAILROAD MEDICARE
GA000964213AMedicaid
GA000964213AMedicaid
FL47888ZMedicare PIN
FLP00662219OtherRAILROAD MEDICARE
FLK1951AMedicare PIN
FLK1951AMedicare PIN