Provider Demographics
NPI:1841321288
Name:KAISER, LISA L (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:KAISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE NW 3300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-8394
Mailing Address - Fax:937-208-8388
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE NW 3300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-8394
Practice Address - Fax:937-208-8388
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35087164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2801034Medicaid
OH4217452Medicare PIN
OHP00463507Medicare PIN
OHH078023Medicare PIN
OH2801034Medicaid