Healthcare Provider Details

I. General information

NPI: 1407817737
Provider Name (Legal Business Name): LYDIA W KEISLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HAZEL ST SUITE 101
CARTHAGE MO
64836-2850
US

IV. Provider business mailing address

1515 HAZEL ST SUITE 101
CARTHAGE MO
64836-2850
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-0188
  • Fax: 417-358-4612
Mailing address:
  • Phone: 417-358-0188
  • Fax: 417-358-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number101562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: