Basic Information
| Provider Information | |||||||||
| NPI: | 1467475756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KESLIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2154 | ||||||||
| Address2: | |||||||||
| City: | SKYLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287762154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752644 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 PAN AMERICAN EAST FWY NE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871093427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058562735 | ||||||||
| FaxNumber: | 5058562749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 70-148 | NM | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 10001051 | 01 | NM | LOVELACE | OTHER | NM001R88 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER | 7286515 | 01 | NM | AETNA | OTHER | 24950 | 05 | NM | MEDICAID | 3545500 | 01 | NM | CIGNA | OTHER | NM0012Q04 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER | 34P718001 | 01 | NM | MEDICARE PTAN | OTHER | 202020906 | 01 | NM | PRESBYTERIAN | OTHER | 2665015 | 01 | NM | UNITED HEALTH CARE | OTHER | 10733 | 01 | NM | HMN | OTHER | 343731801 | 01 | NM | MEDICARE PTAN | OTHER | PROVP13821 | 01 | NM | MOLINA | OTHER |