Healthcare Provider Details

I. General information

NPI: 1780677484
Provider Name (Legal Business Name): RACHEL E KALTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 INDIAN BOUNDARY RD STE 200
CHESTERTON IN
46304-1519
US

IV. Provider business mailing address

2025 W OKLAHOMA AVE SUITE 124
MILWAUKEE WI
53215-4455
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-6566
  • Fax: 219-395-8077
Mailing address:
  • Phone: 414-672-5250
  • Fax: 414-672-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40064
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: