Provider Demographics
NPI:1174573638
Name:KAISER, JACQUELINE S (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:KAISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065462L2085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0867444000OtherIBC - PC/KHPE
PAH24694Medicare UPIN
PA0018428690025Medicaid
PA3486801OtherCIGNA HMO/PPO
PA2669978OtherAETNA
PA46128-MD065462LOtherHEALTH PARTNERS
PA923336OtherHIGHMARK BLUE SHIELD
PA0867444000OtherAMERIHEALTH/INTERCOUNTY
PA1162349OtherKEYSTONE MERCY
PA047435HMMMedicare ID - Type Unspecified