Michael Ketelaar, M. D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

C39467 Issued in CA

Practice address

1231 W Vine St
Lodi, CA 95240-5109

Phone

(209) 368-7121

Fax

(209) 368-5750

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JDABCA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Donald E Hunneshagen M D Inc & Michael Ketelaar M D PTR Hunneshagen DO

  • Surgery Physician
  • Lodi, CA
  • NPI 1881735835
  NPD (past) Authorized official
• Manshadi Heart Institute Inc

  • Interventional Cardiology Physician
  • Stockton, CA
  • NPI 1225380603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245196800000",
    "number": "1487705935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 W VINE ST",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-368-7121",
            "fax_number": "209-368-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 W VINE ST",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-368-7121",
            "fax_number": "209-368-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELAAR",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2009-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C39467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Keithley, D.D.S.
• Robert J Kellar Jr., MD
• Hannah Esther Keller, PA
• Patricia Lynn Kennel, M.D.
• Clifford Dean Kerr, DDS
• Kevin L Fleming, DDS a Professional Corporation
• Kevin S & Tina S Watt
• Kevin S & Tina S Watt (Woodlake Chiropractic Center)
• Aman Khan
• Faatihah Khan

• Surgery Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.