Provider Demographics
NPI:1447967161
Name:KESSEL, MICHAEL JAMES (ORF)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:KESSEL
Suffix:
Gender:M
Credentials:ORF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-4004
Mailing Address - Country:US
Mailing Address - Phone:904-730-9121
Mailing Address - Fax:904-730-9135
Practice Address - Street 1:8110 CYPRESS PLAZA BLVD
Practice Address - Street 2:#307
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-730-9121
Practice Address - Fax:904-730-9135
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF69335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier