Provider Demographics
NPI:1669417184
Name:KETT, KEVIN GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GERARD
Last Name:KETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CHASE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3352
Mailing Address - Country:US
Mailing Address - Phone:203-573-1435
Mailing Address - Fax:
Practice Address - Street 1:455 CHASE PARKWAY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3352
Practice Address - Country:US
Practice Address - Phone:203-573-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029001207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010029001CT01OtherANTHEM BC & BS
CT029001OtherCONNECTICARE
CT001290014Medicaid
CT13-86973OtherUHC
CT13-86973OtherAMERICHOICE
CTP380226OtherOXFORD HEALTH PLANS
CT01029001OtherCIGNA HEALTH PLANS
CT2V2868OtherHEALTHNET/COMMERCIAL
CT010029001CT04OtherANTHEM BCBS CT
CT206708OtherWELLCARE
CT25-40436OtherUNITED HEALTHCARE
CTP00025374OtherRR MEDICARE
CT0R0352OtherHEALTH NET OF NORTHEAST
CT1669417184Medicaid
CT4124668OtherAETNA HEALTH PLANS
CT874070OtherUSA
CT010029001CT01OtherANTHEM BC & BS
CT4124668OtherAETNA HEALTH PLANS
CT01029001OtherCIGNA HEALTH PLANS