Basic Information
| Provider Information | |||||||||
| NPI: | 1790709558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEESAL | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16347 WILSON FARM DR | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365325280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 83 PROGRESS PKWY | ||||||||
| Address2: | |||||||||
| City: | MARYLAND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630433701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144348174 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R6496 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00353235 | 01 | MO | RR MEDICARE | OTHER | R6496 | 01 | MO | LICENSE | OTHER | ME24072 | 01 | FL | LICENSE | OTHER |