Active NPI
Erika Ketteler, M.D., M.A.
- Vascular Surgery Physician
- Albuquerque, NM
National Provider Identifier
1235142449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- Practice address
- 1501 San Pedro Dr SE
Albuquerque, NM 87108-5153 - Phone
- (505) 265-1711
- Fax
- (505) 256-2811
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | IL | Primary |
Addresses
Primary practice location
1501 San Pedro Dr SE
Albuquerque, NM 87108-5153
Mailing address
124 15TH St SW
Albuquerque, NM 87104-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-111594 | IL | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235142449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 15TH ST SW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871041100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SAN PEDRO DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871085153",
"telephone_number": "505-265-1711",
"fax_number": "505-256-2811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTELER",
"first_name": "ERIKA",
"credential": "M.D., M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.