Provider Demographics
NPI:1063488849
Name:KESSLER, KENNETH DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DAVID
Last Name:KESSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3122
Mailing Address - Country:US
Mailing Address - Phone:504-347-0243
Mailing Address - Fax:504-347-7307
Practice Address - Street 1:4500 10TH ST
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3122
Practice Address - Country:US
Practice Address - Phone:504-347-0243
Practice Address - Fax:504-347-7307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557099Medicaid
LA1557099Medicaid
LA5E532Medicare ID - Type Unspecified