Healthcare Provider Details

I. General information

NPI: 1932227873
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRICS OF BLOOMFIELD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W LONG LAKE RD
BLOOMFIELD HILLS MI
48302-1964
US

IV. Provider business mailing address

1109 W LONG LAKE RD
BLOOMFIELD HILLS MI
48302-1964
US

V. Phone/Fax

Practice location:
  • Phone: 248-723-2400
  • Fax:
Mailing address:
  • Phone: 248-723-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: STEVE KALLABAT
Title or Position: PRESIDENT
Credential: MD
Phone: 248-723-2400