Healthcare Provider Details

I. General information

NPI: 1760455869
Provider Name (Legal Business Name): JACOB KALO M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 E 8 MILE RD
DETROIT MI
48205-1444
US

IV. Provider business mailing address

28477 HOOVER RD
WARREN MI
48093-5438
US

V. Phone/Fax

Practice location:
  • Phone: 313-526-3600
  • Fax: 313-526-3603
Mailing address:
  • Phone: 586-751-7070
  • Fax: 586-751-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301040053
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301040053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: