Provider Demographics
NPI:1710171335
Name:KAISER, MARK RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RAYMOND
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 1:301 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2227
Mailing Address - Country:US
Mailing Address - Phone:772-286-7081
Mailing Address - Fax:772-286-7785
Practice Address - Street 1:301 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2227
Practice Address - Country:US
Practice Address - Phone:772-286-7081
Practice Address - Fax:772-286-7785
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062247207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF54796Medicare UPIN
FL18686ZMedicare PIN