Healthcare Provider Details

I. General information

NPI: 1457568966
Provider Name (Legal Business Name): ROBERT KALLUS M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 177TH ST
LANSING IL
60438-1722
US

IV. Provider business mailing address

555 GOLFVIEW BLVD APT B
VALPARAISO IN
46385-9491
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-7310
  • Fax:
Mailing address:
  • Phone: 219-531-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001592A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: