Provider Demographics
NPI:1528036035
Name:KAERCHER, KIP L (DO)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:L
Last Name:KAERCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-9042
Practice Address - Street 1:3955 PATIENT CARE WAY
Practice Address - Street 2:SUITE B
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-882-6643
Practice Address - Fax:517-882-1949
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI44440543Medicaid
MIG14049Medicare UPIN
MION56170Medicare ID - Type Unspecified