Provider Demographics
NPI:1760492789
Name:KAISER, HEATHER S (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
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 1:6680 POE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2854
Mailing Address - Country:US
Mailing Address - Phone:937-280-8366
Mailing Address - Fax:937-280-8373
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:CANCER CARE CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-771-2422
Practice Address - Fax:937-245-6308
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350849662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2522667Medicaid
OHI23186Medicare UPIN
OHKA4149054Medicare PIN