Provider Demographics
NPI:1518272129
Name:KEITH B. KESSEL M.D., LLC
Entity Type:Organization
Organization Name:KEITH B. KESSEL M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-221-6070
Mailing Address - Street 1:745 OLIVE ST STE 109
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2250
Mailing Address - Country:US
Mailing Address - Phone:318-221-6070
Mailing Address - Fax:318-221-6069
Practice Address - Street 1:745 OLIVE ST STE 109
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2250
Practice Address - Country:US
Practice Address - Phone:318-221-6070
Practice Address - Fax:318-221-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10227R2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982237Medicaid
LA1982237Medicaid