Healthcare Provider Details

I. General information

NPI: 1720076300
Provider Name (Legal Business Name): JEFFREY BRENT KESSLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W WHITTAKER ST SUITE 3
SALEM IL
62881-2007
US

IV. Provider business mailing address

PO BOX 460
SALEM IL
62881-0460
US

V. Phone/Fax

Practice location:
  • Phone: 618-740-0341
  • Fax: 618-740-0343
Mailing address:
  • Phone: 618-740-0341
  • Fax: 618-740-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: