Healthcare Provider Details

I. General information

NPI: 1528036035
Provider Name (Legal Business Name): KIP L KAERCHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PATIENT CARE WAY SUITE B
LANSING MI
48911-4299
US

IV. Provider business mailing address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-6643
  • Fax: 517-882-1949
Mailing address:
  • Phone: 517-374-7600
  • Fax: 517-374-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: