1043824766 NPI number — LAUREL G KAISER

Table of content: (NPI 1043824766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043824766 NPI number — LAUREL G KAISER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL G KAISER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043824766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5277 GOLFWAY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDHURST
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-282-7244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25201 CHAGRIN BLVD STE 390
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-282-7244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARLAND
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING AGENT
Authorized Official Telephone Number:
404-213-5329

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912299306 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".