Healthcare Provider Details

I. General information

NPI: 1578590279
Provider Name (Legal Business Name): THOMAS MELVIN KESSLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 ARIZONA 260
LAKESIDE AZ
85929
US

IV. Provider business mailing address

PO BOX 129 1571 E BROADWAY
GALLATIN TN
37066-0129
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-4379
  • Fax:
Mailing address:
  • Phone: 615-230-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34130
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: