DR. KEVAN E KETTERLING (NPI# 1770563710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770563710 |
| Entity Type | Individual |
| Full Name | DR. KEVAN E KETTERLING |
| Credential | M.D. |
| Practice Address |
2525 Kaneville Rd Geneva IL 60134-2578 |
| Practice Telephone | 6305841400 |
| Practice Fax Number | 6305841733 |
| Mailing Telephone | 6305841400 |
| Mailing Fax Number | 6305841733 |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-02-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 36082353 | IL | Allopathic & Osteopathic Physicians |
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
036082353 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE FACILITY | 141081 | 01 |
| IL | RAILROAD MEDICARE | 200007873 | 01 |
| IL | 036082353 | 05 | |
| IL | RAILROAD GROUP | CF2064 | 01 |
| Street Address |
2525 KANEVILLE RD |
| City | GENEVA |
| State | IL |
| Zip Code | 60134-2578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659373751 | Jeffrey A Jacoby | Orthopaedic Surgery | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2005-08-10 |
| 1982238135 | Rena Ranallo | Physician Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2020-02-26 |
| 1558854620 | Athletic & Therapeutic Institute of Bourbonnais LLC | Durable Medical Equipment & Medical Supplies | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2018-06-12 |
| 1316489842 | Cameron Weess | Physician Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2016-11-15 |
| 1386190429 | Shawn Roney | Physical Therapist | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2016-08-29 |
| 1407309453 | Jenny Flanigan | Physical Therapy Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2016-07-26 |
| 1730551771 | Joseph Reibel | Physician Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2015-10-29 |
| 1174994818 | Ellen M Hunka | Occupational Therapy Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2015-10-07 |
| 1154708030 | Fox Valley Orthopedic Associates Sc | Pharmacy Technician | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2015-04-30 |
| 1811332240 | Jessica Rae Shanahan | Physician Assistant | 2525 Kaneville Rd, Geneva, IL 60134-2578 | 2013-04-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902403918 | Glenda Creighton | Physical Therapist | 0n 801 Friendship Way, Geneva, IL 60134 | 2020-10-02 |
| 1467912212 | Cierra Monae French | Family Medicine | Northwestern Medicine Delnor Hospital, 300 Randall Road, Geneva, IL 60134 | 2019-03-20 |
| 1497246227 | Linda Huber | Psychologist | 1541 E Fabyan Pkwy Ste 101, Geneva, IL 60134 | 2018-05-29 |
| 1003305459 | Nicole Collins | Specialist/Technologist | 1125 Lewis Road, Geneva, IL 60134 | 2018-05-01 |
| 1013438704 | Emily Byars | Clinic/Center | 1111 Greenfield Circle, Geneva, IL 60134 | 2017-07-03 |
| 1982142980 | Samantha Courtney | Counselor | 1120 Randall Ct., Geneva, IL 60134 | 2017-02-09 |
| 1073055026 | Physical Rehabilitation Clinics | Physical Therapist | 507 S. 3rd St. Unit I, Geneva, IL 60134 | 2016-11-08 |
| 1265868707 | Gina Marie Gilchrist | Dietitian, Registered | 39w479 W Haladay Ln, Geneva, IL 60134 | 2013-09-16 |
| 1770823585 | William A. Goodfellow | General Practice | 1010 S. Batavia Ave., Geneva, IL 60134 | 2013-02-15 |
| 1467705392 | Kylie L Mack | Physician Assistant | 351 Delnor Dr #100, Geneva, IL 60134 | 2012-10-16 |
| Find all providers in zip 60134 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417902867 | Olaf U Lieberg | Orthopaedic Surgery | 789 Pre Emption Rd, Suite 600, Geneva, NY 14456-2069 | 2006-05-24 |
| 1376949271 | Finger Lakes Bone & Joint LLP | Orthopaedic Surgery | 875 Pre Emption Rd, Geneva, NY 14456-2042 | 2014-11-05 |
| 1316984933 | Daniel Alexander | Orthopaedic Surgery | 875 Pre Emption Rd, Geneva, NY 14456-2042 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063048395 | Dr Ouilife LLC | Orthopaedic Surgery | 640 S Federal St Apt 410, Chicago, IL 60605-1800 | 2020-03-18 |
| 1316437890 | Darcy L Marr | Orthopaedic Surgery | 3030 Salt Creek Lane, Suite 100, Arlington Heights, IL 60005 | 2018-05-10 |
| 1568851251 | Benjamin Scott Kester | Orthopaedic Surgery | 1725 W Harrison St Ste Rush, Chicago, IL 60612-3841 | 2015-01-18 |
| 1609041565 | Sheryl Lynn Lipnick | Orthopaedic Surgery | 1585 N. Barrington Rd Ste 101, Drs. Bldg. 2, Hoffman Estates, IL 60169-5019 | 2008-04-22 |
| 1295937555 | Gregory Lamar Primus | Orthopaedic Surgery | 7543 183rd St, Tinley Park, IL 60477-6208 | 2007-05-31 |
| 1154454635 | Benjamin Domb | Orthopaedic Surgery | 999 E Touhy Ave Ste 450, Des Plaines, IL 60018-2748 | 2007-03-13 |
| 1518981612 | Sean Daniel Odell | Orthopaedic Surgery | 375 S Roselle Rd, Schaumburg, IL 60193-5544 | 2006-07-26 |
| 1568419463 | Mark K. Bowen | Orthopaedic Surgery | 680 N Lake Shore Dr Ste 924, Chicago, IL 60611 | 2006-05-27 |
| 1639146103 | Jean Benoit Houle | Orthopaedic Surgery | 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2006-03-03 |
| 1093792277 | Scott Eric Urch | Orthopaedic Surgery | 503 E Grant St, Macomb, IL 61455-3313 | 2005-12-28 |
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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.