Organization
CK SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES WILLIS KESSLER MD PA (OWNER)
(719) 565-1000
Entity
Organization
Contact information
Practice address
650 DITTMER AVENUE, PUEBLO, CO 81005-1212
(719) 565-1000
(719) 565-1111
Mailing address
650 DITTMER AVENUE, PUEBLO, CO 81005-1212
(719) 565-1000
(719) 565-1111
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KE32539
BLUE CROSS BLUE SHIELD
CO
Enumeration date
07/18/2006
Last updated
10/25/2007
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