Provider Demographics
NPI:1548434772
Name:KETKO, ANASTASIA K (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:K
Last Name:KETKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9325 UPLAND LANE N
Mailing Address - Street 2:SUITE 360
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:612-813-6475
Mailing Address - Fax:
Practice Address - Street 1:9325 UPLAND LANE N
Practice Address - Street 2:SUITE 360
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:612-813-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010979592080N0001X
ND153662080N0001X
MN577952080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine