Provider Demographics
NPI:1326142068
Name:KAISER, ANDREW PHILIP (P T)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILIP
Last Name:KAISER
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3034
Mailing Address - Country:US
Mailing Address - Phone:952-470-8555
Mailing Address - Fax:
Practice Address - Street 1:386 OAK ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3034
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist