Provider Demographics
NPI:1326040965
Name:KESSLER, STEPHEN EMERSON (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EMERSON
Last Name:KESSLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 63RD ST
Mailing Address - Street 2:BLDG 3 SUITE 114
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1620
Mailing Address - Country:US
Mailing Address - Phone:480-981-2888
Mailing Address - Fax:480-654-0599
Practice Address - Street 1:130 S 63RD ST
Practice Address - Street 2:BLDG 3 SUITE 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1620
Practice Address - Country:US
Practice Address - Phone:480-981-2888
Practice Address - Fax:480-654-0599
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1730207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ257354Medicaid
D47238Medicare UPIN
AZ257354Medicaid