Healthcare Provider Details

I. General information

NPI: 1164764742
Provider Name (Legal Business Name): JENNIFER KAISER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

5687 COUNTY ROAD C
VESPER WI
54489-9619
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2401
  • Fax:
Mailing address:
  • Phone: 312-342-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9149530-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: