Provider Demographics
NPI:1649353087
Name:JACQUELINE L. KAISER M.D., P.A.
Entity type:Organization
Organization Name:JACQUELINE L. KAISER M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LEVY
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-628-1718
Mailing Address - Street 1:255 N LAKEMONT AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61763208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG30535Medicare UPIN
FL28991AMedicare PIN