Basic Information
| Provider Information | |||||||||
| NPI: | 1629061841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAISERMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ARDEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2393 SCHUST RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486031334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897932820 | ||||||||
| FaxNumber: | 9897551463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1671 E US 23 | ||||||||
| Address2: | |||||||||
| City: | EAST TAWAS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487309302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893624401 | ||||||||
| FaxNumber: | 9893628141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4301044582 | MI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 382621705051 | 01 | MI | COMMUNITY CHOICE | OTHER | 1427090976 | 01 | MI | GROUP NPI | OTHER | 1723957 | 05 | MI | MEDICAID | 0G36036 | 01 | MI | MEDICARE | OTHER |