Provider Demographics
NPI:1760441968
Name:KETCHEL, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KETCHEL
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 1:1760 E RIVER RD
Mailing Address - Street 2:350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7760
Practice Address - Street 1:2625 N CRAYCROFT RD
Practice Address - Street 2:STE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2254
Practice Address - Country:US
Practice Address - Phone:520-324-2409
Practice Address - Fax:520-324-2454
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7839207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ205973Medicaid
AZ860938204OtherTIN
AZ860938204OtherTIN
AZC99750Medicare UPIN