DONALD LEE KETTWICH (NPI# 1124179486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124179486 |
| Entity Type | Individual |
| Full Name | DONALD LEE KETTWICH |
| Credential | M.D. |
| Practice Address |
711 Encino Pl Ne Suite E Albuquerque NM 87102-2619 |
| Practice Telephone | 5052455737 |
| Practice Fax Number | 5052455739 |
| Mailing Telephone | 5052455737 |
| Mailing Fax Number | 5052455739 |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2008-05-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 76-208 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | UNITED HEALTHCARE | 85-0284119 | 01 |
| NM | CIGNA | 85-0284119 | 01 |
| NM | N.M. PIPE TRADES | 85-0284119 | 01 |
| NM | IBEW-NECA | 85-0284119 | 01 |
| NM | JOHN ALDEN | 85-0284119 | 01 |
| NM | LOVELACE HEALTH PLAN | 85-0284119 | 01 |
| NM | UNITED AMERICAN | 85-0284119 | 01 |
| NM | E.B.C. | 85-0284119 | 01 |
| NM | PRINCIPAL LIFE INS. | 85-0284119 | 01 |
| NM | BLUE CROSS-BLUE SHIELD-NM | 00NM019E05 | 01 |
| NM | UPREHS | 85-0284119 | 01 |
| NM | PRESBYTERIAN HEALTH PLAN | 201005185 | 01 |
| NM | GEHA | 85-0284119 | 01 |
| NM | AETNA | 85-0284119 | 01 |
| NM | 00015941 | 05 | |
| NM | TRICARE FOR LIFE | 85-0284119 | 01 |
| NM | AARP | 85-0284119 | 01 |
| Street Address |
711 ENCINO PL NE SUITE E |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87102-2619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245208867 | Thomas Henry Bien | Psychologist | 711 Encino Pl Ne, Suite D, Albuquerque, NM 87102-2619 | 2006-03-09 |
| 1205068236 | George Higgins Family Practice LLC | Clinic/Center | 711 Encino Pl Ne, Suite D, Albuquerque, NM 87102-2619 | 2009-08-08 |
| 1003006040 | New Mexico Surgical Associates, Pa | Specialist | 711 Encino Pl Ne, Albuquerque, NM 87102-2619 | 2007-07-26 |
| 1770609497 | Podiatry Associates of New Mexico Ltd | Podiatrist | 711 Encino Pl Ne, Suite G, Albuquerque, NM 87102-2619 | 2007-03-22 |
| 1154412740 | Scott Brown Md LLC | Family Medicine | 711 Encino Pl Ne, Suite D, Albuquerque, NM 87102-2619 | 2006-09-27 |
| 1174622666 | James M. Wilterding, M.d., LLC | Clinic/Center | 711 Encino Pl Ne, Suite D, Albuquerque, NM 87102-2619 | 2006-09-21 |
| 1205843240 | Scott Brown | Family Medicine | 711 Encino Pl Ne, Suite D, Albuquerque, NM 87102-2619 | 2006-08-02 |
| 1972565539 | Joseph P Lopez | Specialist | 711 Encino Pl Ne, Albuquerque, NM 87102-2619 | 2006-04-06 |
| 1831151497 | Robert J Lowe | Specialist | 711 Encino Pl Ne, Albuquerque, NM 87102-2619 | 2006-04-06 |
| 1487641981 | Stephen Lampkin Gregg | Internal Medicine | 711 Encino Pl Ne, Suite B, Albuquerque, NM 87102-2619 | 2005-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454937 | Julie Wood | Acupuncturist | 1600 Luna Circle Nw, Albuquerque, NM 87102 | 2020-10-16 |
| 1770121410 | Emily Perez | Counselor | 218 Broadway Ne, Albuquerque, NM 87102 | 2019-12-12 |
| 1417503392 | Tess Holtry | Behavior Technician | 1424 Walter St Nw, Albuquerque, NM 87102 | 2019-08-15 |
| 1942867486 | Christy E Cheromiah | Behavioral Analyst | Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-05-21 |
| 1730744103 | Faith Petra Maxwell | Behavior Technician | 900 Arno St, Albuquerque, NM 87102 | 2019-05-01 |
| 1568923761 | Storm Swinford | Behavioral Analyst | Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-29 |
| 1093276651 | Tina Marie Trujillo | Behavioral Analyst | Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-27 |
| 1861950370 | Meghan Montoya | Student in an Organized Health Care Education/Training Program | 801 Camino De Salud, Albuquerque, NM 87102 | 2019-03-05 |
| 1174099329 | Dilshani N Tyson | Counselor | 600 1st Street Nw Ste 200, Albuquerque, NM 87102 | 2018-10-15 |
| 1962987925 | Tania L Goldfeder | Social Worker | New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 | 2018-09-26 |
| Find all providers in zip 87102 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174849210 | Jessica Megan Chen Ming | Urology | 1004 Columbia Dr Ne, Albuquerque, NM 87106-2627 | 2010-04-14 |
| 1174525257 | Damara Lee Kaplan | Urology | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2005-06-02 |
| 1023405834 | Laura Anne Mihalko | Urology | Msc 10 5610, University of New Mexico, Albuquerque, NM 87131-0001 | 2015-04-20 |
| 1639598972 | Tomy Yojan Perez | Urology | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2014-04-15 |
| 1750704102 | Md for Men, LLC | Urology | 8300 Carmel Ave Ne, Suite 303, Albuquerque, NM 87122-3147 | 2014-01-21 |
| 1649607128 | Aaron J Geswaldo Do PC | Urology | 8100 Wyoming Blvd Ne, Suite M4 #357, Albuquerque, NM 87113-1946 | 2013-09-30 |
| 1285991851 | Jonathan Scott Nelson | Urology | Msc 10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2012-04-19 |
| 1265798771 | Christopher Paul Slayden | Urology | 1 University of New Mexico, Msc 10-5610, Albuquerque, NM 87131-0001 | 2012-04-09 |
| 1043584097 | Frances Maria Alba | Urology | 1 University of New Mexico, Dept. of Surgery. Msc10-5610, Albuquerque, NM 87131-0001 | 2012-03-07 |
| 1689966145 | Maxx Gallegos | Urology | 2211 Lomas Blvd Ne, Albuquerque, NM 87131-2020 | 2011-05-03 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.