Provider Demographics
NPI:1790670958
Name:KETNER ORTHOPEDICS PLLC
Entity type:Organization
Organization Name:KETNER ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KETNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-515-1859
Mailing Address - Street 1:264 WORDSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2529
Mailing Address - Country:US
Mailing Address - Phone:248-515-1859
Mailing Address - Fax:
Practice Address - Street 1:5624 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1926
Practice Address - Country:US
Practice Address - Phone:248-515-1859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty