Healthcare Provider Details

I. General information

NPI: 1730159229
Provider Name (Legal Business Name): THOMAS F KALKHOFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 23RD ST STE C
SPIRIT LAKE IA
51360-1158
US

IV. Provider business mailing address

2700 23RD ST STE C
SPIRIT LAKE IA
51360-1158
US

V. Phone/Fax

Practice location:
  • Phone: 712-336-3750
  • Fax: 712-336-3730
Mailing address:
  • Phone: 712-336-3750
  • Fax: 712-336-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02149
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: