Provider Demographics
NPI:1508905902
Name:KESSELMAN, EDWARD N (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:N
Last Name:KESSELMAN
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 1:5257 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2228
Mailing Address - Country:US
Mailing Address - Phone:303-972-5493
Mailing Address - Fax:
Practice Address - Street 1:5257 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2228
Practice Address - Country:US
Practice Address - Phone:303-972-5493
Practice Address - Fax:303-972-5356
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
001292OtherKAISER-COMMERCIAL NUMBER
CO01207745Medicaid
001292OtherKAISER-COMMERCIAL NUMBER
COCK10200Medicare PIN