MEDICARE: MARK KAISER CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	213000268	IL
2	224P00000X	Prosthetist	211000255	IL

General Provider Information

NPI Number	:	1275030082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK KAISER CPO

Provider Business Mailing Address
First Line	:	1S376 SUMMIT AVE
Second Line	:	COURT E
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3985
Country	:	US
Telephone Number	:	630-705-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	8641 W 95TH ST
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1730
Country	:	US
Telephone Number	:	708-599-8336
Fax Number	:	708-599-2792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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