Individual
GEORGE KAISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
405 W GRAND AVE, DAYTON, OH 45405-4720
(937) 723-3211
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34003740
OH
207Q00000X
Family Medicine Physician
34.003740
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0565231
—
OH
05
—
2427636
—
OH
01
—
9337931
MEDICARE GROUP
OH
01
—
9337933
MEDICARE GROUP
OH
Enumeration date
08/15/2006
Last updated
05/05/2020
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