Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MYLES JULIAN KETCHUM, M.D., PH.D.
Active Sole ProprietorMYLES JULIAN KETCHUM, M.D., PH.D. is a Addiction Medicine (Family Practice) healthcare provider located in SANTA ROSA, California. NPI 1093249864 is currently active in the NPPES registry. Verify at CMS.
Addiction Medicine (Family Practice) · SANTA ROSA, CA
Registration Details
- NPI Number
- 1093249864
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 18, 2017 (9.3570976313613 yrs)
- Last Updated
- May 27, 2025
- Licenses
-
61-25999 (CA)1211497 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2360 MENDOCINO AVESANTA ROSA, CA, 954033153Browse CA providers · Browse ZIP 95403
- Phone
- 7075735250
- Fax
- 7075735458
- Primary Specialty
-
Addiction Medicine (Family Practice)
207QA0401X
- Additional Specialty
- Addiction Medicine (Family Practice)
Other Addiction Medicine (Family Practice) Providers in SANTA ROSA, CA
| Name | Credential | NPI |
|---|---|---|
| DR. ELYSE RAE EISENBERG | M.D. | 1316966815 |
| DR. PARKER ANDREW DUNCAN DIAZ | MD, MPH, FAAFP | 1033434923 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.