Healthcare Provider Details

I. General information

NPI: 1649920885
Provider Name (Legal Business Name): KALEB MATTHEW MIKAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LONGWATER DR
NORWELL MA
02061-1639
US

IV. Provider business mailing address

600 LONGWATER DR
NORWELL MA
02061-1639
US

V. Phone/Fax

Practice location:
  • Phone: 781-745-3322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1022926
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: