Provider Demographics
NPI:1528566163
Name:KAISER, EDWARD JOHN
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:KAISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-7717
Mailing Address - Country:US
Mailing Address - Phone:302-602-3686
Mailing Address - Fax:
Practice Address - Street 1:5 MARGIE DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-7717
Practice Address - Country:US
Practice Address - Phone:302-602-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program