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NPI Code Detail

MEDICARE: DEITER MICHAEL KAIZER PA-C

MEDICARE: DEITER MICHAEL KAIZER PA-C
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
1363AM0700XMedical Physician AssistantPA9116089FL
2363AM0700XMedical Physician AssistantPA10005325WA

General Provider Information

NPI Number : 1558540385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEITER MICHAEL KAIZER PA-C
Provider Business Mailing Address
First Line : 101 E 26TH ST
Second Line :
City : TACOMA
State : WA
Zip : 98421-1108
Country : US
Telephone Number : 253-597-4550
Fax Number : 253-722-1546
Provider Business Practice Location Address
First Line : 134 188TH ST S
Second Line :
City : SPANAWAY
State : WA
Zip : 98387-4618
Country : US
Telephone Number : 253-847-8856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 06/22/2022

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