Provider Demographics
NPI:1255511721
Name:KAISER, JACQUELINE LEVY (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEVY
Last Name:KAISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 N LAKEMONT AVE
Mailing Address - Street 2:#100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3229
Mailing Address - Country:US
Mailing Address - Phone:407-628-1718
Mailing Address - Fax:407-628-0925
Practice Address - Street 1:255 N LAKEMONT AVE
Practice Address - Street 2:#100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3229
Practice Address - Country:US
Practice Address - Phone:407-628-1718
Practice Address - Fax:407-628-0925
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61763208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG30535Medicare UPIN
FL28991AMedicare PIN