Provider Demographics
NPI:1487307021
Name:KAISER, PHILIP PAUL (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:PAUL
Last Name:KAISER
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 SHUMAN BLVD STE 240W
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8113
Mailing Address - Country:US
Mailing Address - Phone:630-868-2200
Mailing Address - Fax:
Practice Address - Street 1:155 E BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:630-868-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024762367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.024762OtherIL DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL309.018338OtherIL DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION