Provider Demographics
NPI:1649280363
Name:KESSINGER, MICHAEL W (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:KESSINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:STE # 059
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-297-3199
Mailing Address - Fax:216-297-3213
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:STE # 059
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-297-3199
Practice Address - Fax:216-297-3213
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003033K213EP1101X
KY00248213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2049376Medicaid
OH2049376Medicaid
OH0833401Medicare PIN