Provider Demographics
NPI:1619007341
Name:KAISER, DAVID L (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KAISER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LINKS DR APT 102R
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5400
Mailing Address - Country:US
Mailing Address - Phone:941-900-9033
Mailing Address - Fax:
Practice Address - Street 1:124 LINKS DR APT 102R
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-5400
Practice Address - Country:US
Practice Address - Phone:941-900-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80217213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01700053Medicaid