Provider Demographics
NPI:1720076300
Name:KESSLER, JEFFREY BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0460
Mailing Address - Country:US
Mailing Address - Phone:618-740-0341
Mailing Address - Fax:618-740-0343
Practice Address - Street 1:1325 W WHITTAKER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2007
Practice Address - Country:US
Practice Address - Phone:618-740-0341
Practice Address - Fax:618-740-0343
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD51909Medicare UPIN
ILK46330Medicare PIN