Provider Demographics
NPI:1124204177
Name:KAISER, MEGHANN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHANN
Middle Name:LEE
Last Name:KAISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 40TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3356
Mailing Address - Country:US
Mailing Address - Phone:602-633-3721
Mailing Address - Fax:602-953-5466
Practice Address - Street 1:16601 N 40TH ST STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3356
Practice Address - Country:US
Practice Address - Phone:602-633-3721
Practice Address - Fax:602-953-5466
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ580562086S0102X
CAA1025362086S0102X
SC375302086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861707770Medicaid
AZ549539Medicaid
SCQ0149NMedicaid