Provider Demographics
NPI:1588657712
Name:KAYSER, MELEK RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:MELEK
Middle Name:RONALD
Last Name:KAYSER
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 1:29167 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1331
Mailing Address - Country:US
Mailing Address - Phone:586-776-3223
Mailing Address - Fax:586-776-6670
Practice Address - Street 1:29167 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1331
Practice Address - Country:US
Practice Address - Phone:586-776-3223
Practice Address - Fax:586-776-6670
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010531952086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500536OtherBCBS
MI3325912-10Medicaid
P93479OtherBCN
P93479OtherBCN
034730Medicare ID - Type Unspecified