Healthcare Provider Details

I. General information

NPI: 1679530307
Provider Name (Legal Business Name): DAVID PAUL KESEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E 2ND ST
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

446 MORGAN ST
CINCINNATI OH
45206-2348
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35044161
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35044161K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: