Basic Information
| Provider Information | |||||||||
| NPI: | 1689620049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KESSLER | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3130 MADISON STREET | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 MADISON STREET | ||||||||
| Address2: | CAPITAL REGION MEDICAL CENTER | ||||||||
| City: | JEFFERSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34008371 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 103876 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00186937 | 01 | RR MEDICARE | OTHER | 2528134 | 05 | OH | MEDICAID | 000000349644 | 01 | OH | BCBS | OTHER |