Provider Demographics
NPI:1558685495
Name:KESLER, DOUGLAS D (PA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:D
Last Name:KESLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8450 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1381
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-2170
Practice Address - Street 1:1411 S CREASY LANE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7433
Practice Address - Country:US
Practice Address - Phone:765-447-4165
Practice Address - Fax:765-447-6978
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001164A363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000651768OtherANTHEM
IN815010SMedicare PIN
IN000000651768OtherANTHEM