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NPI Code Detail

MEDICARE: DR. DENNIS KEESAL M.D.

MEDICARE: DR. DENNIS KEESAL M.D.
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
1207P00000XEmergency Medicine PhysicianR6496MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00353235OTHERMORR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2R6496OTHERMOLICENSE
3ME24072OTHERFLLICENSE

General Provider Information

NPI Number : 1790709558
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS KEESAL M.D.
Provider Business Mailing Address
First Line : 16347 WILSON FARM DR
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63005-4542
Country : US
Telephone Number : 636-532-5280
Fax Number :
Provider Business Practice Location Address
First Line : 83 PROGRESS PKWY
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3701
Country : US
Telephone Number : 314-434-8174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 11/13/2011

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