Basic Information
Provider Information | |||||||||
NPI: | 1124005244 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KESSLER | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 39000 BOB HOPE DR | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922703221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603403911 | ||||||||
FaxNumber: | 7608378876 | ||||||||
Practice Location | |||||||||
Address1: | 39000 BOB HOPE DR | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922703221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603403911 | ||||||||
FaxNumber: | 7608378876 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/29/2005 | ||||||||
LastUpdateDate: | 10/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | C52714 | CA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | 35338 | CO | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 0594119 | 05 | IA |   | MEDICAID | 100451170A | 05 | KS |   | MEDICAID | 3506685 | 05 | MT |   | MEDICAID | 118365600 | 05 | WY |   | MEDICAID | 09674053 | 05 | MS |   | MEDICAID | 84113438513 | 05 | NE |   | MEDICAID | 89928873 | 05 | CO |   | MEDICAID | 47933208 | 05 | NM |   | MEDICAID |