Provider Demographics
NPI:1477782340
Name:KAISER, KRISTINE (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:KAISER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2634
Mailing Address - Country:US
Mailing Address - Phone:313-624-8417
Mailing Address - Fax:313-357-7074
Practice Address - Street 1:20200 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2634
Practice Address - Country:US
Practice Address - Phone:313-624-8417
Practice Address - Fax:313-357-7074
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094229207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty