Doctor Name: | SID E KESSINGER |
NPI Number: | 1316204266 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CST, RSA |
License Number: | 237000110 |
Business Practice Address: | 1604 Visa Dr Ste. 2 Normal, IL - 617612195 |
Business Phone Number: | 3098464716 |
Business Fax Number: | |
Mailing Address: | 1604 Visa Dr, Ste. 2 NORMAL |
State: | IL |
Postal Code: | 617612195 |
Phone Number: | 3098464716 |
Fax Number: | |
NPI Enumeration Date: | 04/17/2012 |
NPI Last Update Date: | 04/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | 237000110 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |