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NPI Code Detail

MEDICARE: GORDON KALO CRNA

MEDICARE: GORDON KALO CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704120512MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063496867
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON KALO CRNA
Provider Business Mailing Address
First Line : 2393 SCHUST RD
Second Line :
City : SAGINAW
State : MI
Zip : 48603-1334
Country : US
Telephone Number : 989-793-2820
Fax Number : 989-755-1463
Provider Business Practice Location Address
First Line : 200 HEMLOCK ST
Second Line :
City : TAWAS CITY
State : MI
Zip : 48763-9237
Country : US
Telephone Number : 989-362-0153
Fax Number : 989-362-4683
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 02/28/2018

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Directions to “ GORDON KALO CRNA” Practice Location

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