Provider Demographics
NPI:1609037324
Name:KAISER, STEFAN LEROY (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:LEROY
Last Name:KAISER
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 1:1101 9TH ST. N
Mailing Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792
Mailing Address - Country:US
Mailing Address - Phone:218-741-0150
Mailing Address - Fax:
Practice Address - Street 1:1101 9TH ST. N
Practice Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792
Practice Address - Country:US
Practice Address - Phone:218-741-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN535912083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1609037324Medicaid
MN1609037324Medicaid
MN840000127Medicare PIN