Healthcare Provider Details

I. General information

NPI: 1619235306
Provider Name (Legal Business Name): CELINE EMILY MESTEL M.D, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 CHESTNUT ST
EVANSVILLE IN
47713-1227
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9355
  • Fax: 812-858-4539
Mailing address:
  • Phone: 812-426-9355
  • Fax: 812-858-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01076752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: