Provider Demographics
NPI:1013949288
Name:KESSLER, CHARLES WILLIS (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIS
Last Name:KESSLER
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 1:650 DITTMER AVENUE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1212
Mailing Address - Country:US
Mailing Address - Phone:719-565-1000
Mailing Address - Fax:719-565-7111
Practice Address - Street 1:650 DITTMER AVENUE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1212
Practice Address - Country:US
Practice Address - Phone:719-565-1000
Practice Address - Fax:719-565-7111
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29619208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21608Medicare UPIN
CO340218Medicare PIN