Provider Demographics
NPI:1508811738
Name:KAISER, LISA A (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:KAISER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:248-652-2708
Mailing Address - Fax:248-652-0205
Practice Address - Street 1:441 S LIVERNOIS RD
Practice Address - Street 2:STE 180
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2584
Practice Address - Country:US
Practice Address - Phone:248-652-2708
Practice Address - Fax:248-652-0205
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1760207RC0200X, 207RP1001X
MI5101012134207RC0200X, 207RP1001X
IN01086479A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4457380Medicaid
MI5101012134OtherSTATE LICENSE #
MI4457380Medicaid
MI5101012134OtherSTATE LICENSE #