Provider Demographics
NPI:1275504219
Name:MITHOEFER, KAI (MD)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:MITHOEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ALLIED DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:617-264-1100
Mailing Address - Fax:617-264-1101
Practice Address - Street 1:40 ALLIED DRIVE
Practice Address - Street 2:
Practice Address - City:DED HAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:617-264-1100
Practice Address - Fax:617-264-1101
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212397207X00000X, 207XX0005X
NY228933-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0198510Medicaid
H59631Medicare UPIN
MAA33838Medicare PIN