Healthcare Provider Details

I. General information

NPI: 1801808365
Provider Name (Legal Business Name): JILL KALCICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 5TH ST
CALUMET MI
49913-1603
US

IV. Provider business mailing address

207 5TH ST
CALUMET MI
49913-1603
US

V. Phone/Fax

Practice location:
  • Phone: 906-370-2248
  • Fax:
Mailing address:
  • Phone: 906-370-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301085014
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: