Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12008005A | IN |
Y | 213EG0000X | General Practice | 12008005A | IN |
NPI | 1003908385 |
---|---|
Provider Name | Dr. Kim Allen Kessler |
First Address | Crown Point, IN 46307-9315 |
Second Address | Crown Point, IN 46307-7615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 19/06/2008 |