Active NPI
Charles Willis Kessler, MD
- Plastic Surgery Physician
- Pueblo, CO
National Provider Identifier
1013949288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 29619
- Practice address
- 650 Dittmer Avenue
Pueblo, CO 81005-1212 - Phone
- (719) 565-1000
- Fax
- (719) 565-7111
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 29619 | CO | Primary |
| Surgery of the Hand (Plastic Surgery) Physician | 2082S0105X | 29619 | CO |
Addresses
Primary practice location
650 Dittmer Avenue
Pueblo, CO 81005-1212
Mailing address
650 Dittmer Avenue
Pueblo, CO 81005-1212
Phone (719) 565-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29619 | CO | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1013949288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 DITTMER AVENUE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810051212",
"telephone_number": "719-565-1000",
"fax_number": "719-565-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 DITTMER AVENUE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810051212",
"telephone_number": "719-565-1000",
"fax_number": "719-565-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KESSLER",
"first_name": "CHARLES",
"middle_name": "WILLIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CO",
"license": "29619",
"primary": true
},
{
"code": "2082S0105X",
"taxonomy_group": "",
"desc": "Plastic Surgery, Surgery of the Hand",
"state": "CO",
"license": "29619",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.