Healthcare Provider Details

I. General information

NPI: 1669485801
Provider Name (Legal Business Name): GREGORY G KALKOFEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREGORY KALKOFEN OD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42550 GARFIELD SUITE 101
CLINTON TWP MI
48038-1644
US

IV. Provider business mailing address

42550 GARFIELD SUITE 101
CLINTON TWP MI
48038-1644
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-9708
  • Fax: 586-263-0280
Mailing address:
  • Phone: 586-263-9708
  • Fax: 586-263-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: