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NPI Code Detail

MEDICARE: DR. MICHAEL KESSLER

MEDICARE: DR. MICHAEL KESSLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071.008495IL

General Provider Information

NPI Number : 1285172205
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL KESSLER
Provider Business Mailing Address
First Line : 3509 CARNOUSTIE DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62712-5548
Country : US
Telephone Number : 217-751-8995
Fax Number :
Provider Business Practice Location Address
First Line : 4481 ASH GROVE DR STE B
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-6359
Country : US
Telephone Number : 217-751-8995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2017
Last Update Date : 11/04/2023

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