Healthcare Provider Details

I. General information

NPI: 1558416495
Provider Name (Legal Business Name): MARIUS LOUIS KESLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

10237 COVE LAKE DR
ORLANDO FL
32836-3757
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax:
Mailing address:
  • Phone: 407-370-4689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: