Provider Demographics
NPI:1407829278
Name:KESSEN, MARCI D (MD)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:D
Last Name:KESSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1641
Mailing Address - Country:US
Mailing Address - Phone:920-351-4530
Mailing Address - Fax:978-620-2348
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1641
Practice Address - Country:US
Practice Address - Phone:920-351-4530
Practice Address - Fax:978-620-2348
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32416900Medicaid
WI68650Medicare ID - Type Unspecified
WIG64315Medicare UPIN
WI32416900Medicaid