Healthcare Provider Details

I. General information

NPI: 1295730471
Provider Name (Legal Business Name): JOSEPH W KAISER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15520 19 MILE RD STE 480
CLINTON TWP MI
48038-6332
US

IV. Provider business mailing address

15520 19 MILE RD STE 480
CLINTON TWP MI
48038-6332
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-1010
  • Fax: 586-228-8570
Mailing address:
  • Phone: 586-228-1010
  • Fax: 586-228-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5101012133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: