TIMOTHY MICHAEL KETTERHAGEN M.D.
NPI 1679848998
Pediatrics - Pediatric Emergency Medicine in Oak Lawn, IL

Q: What is Timothy Ketterhagen's NPI number?

The NPI number for Timothy Ketterhagen is 1679848998. It was assigned to this individual provider in the NPPES registry on March 20, 2012.

Q: What is Timothy Ketterhagen's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.

Active since March 20, 2012PECOS Enrolled

4440 W 95TH ST, OAK LAWN, IL 60453(708) 684-5354 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 3, 2025, Dec 9, 2021, May 24, 2018 (3 updates tracked since 2018).

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About Timothy Michael Ketterhagen M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIMOTHY MICHAEL KETTERHAGEN M.D. (NPI 1679848998) is an individual pediatric emergency medicine provider in Oak Lawn, Illinois, licensed in Illinois (036137365) and active in the NPI registry since March 2012. He is enrolled in Medicare PECOS and maintains a secondary practice location in Chicago.

NPPES Registry Identity

NPI1679848998

Entity TypeIndividualMale

Primary Taxonomy2080P0204X

Provider Legal NameTIMOTHY MICHAEL KETTERHAGENCredential: M.D.

Location Address4440 W 95TH STOak Lawn, IL 60453

Mailing Address29373 Network PlChicago, IL 60673-1293 · (847) 390-5900

Phone(708) 684-5354

Sole ProprietorNo

Enumeration DateMarch 20, 2012

Last NPPES UpdateJuly 3, 20253 updates tracked since enumeration

NPPES CertifiedJuly 3, 2025

✔ NPI 1679848998 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

License✔ Licensed in IL · 036137365

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

4440 W 95TH ST, Oak Lawn, IL 60453

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Secondary Practice Location 1

Location 15841 S Maryland AveChicago, IL 60637-1447 · Phone (773) 702-1000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Timothy Michael Ketterhagen M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK ADRIAN FAASSE MD

Urology