Provider Demographics
NPI:1952386005
Name:JISER, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:JISER
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 1:275 VARNUM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2109
Mailing Address - Country:US
Mailing Address - Phone:978-458-4300
Mailing Address - Fax:
Practice Address - Street 1:275 VARNUM AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2109
Practice Address - Country:US
Practice Address - Phone:978-458-4300
Practice Address - Fax:978-458-4311
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3188329Medicaid
MAHX0901Medicare PIN
MA3188329Medicaid