Healthcare Provider Details

I. General information

NPI: 1306855531
Provider Name (Legal Business Name): JOHN MICHAEL KESSINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH STREET SUITE 309
PANAMA CITY FL
32401
US

IV. Provider business mailing address

801 E 6TH STREET SUITE 309
PANAMA CITY FL
32401
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-9559
  • Fax: 850-785-1136
Mailing address:
  • Phone: 850-785-9559
  • Fax: 850-785-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME0049047
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number10314
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number019642
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: