Healthcare Provider Details

I. General information

NPI: 1972707602
Provider Name (Legal Business Name): MICHAEL A. KALATA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29100 GATEWAY BLVD SUITE 300
FLAT ROCK MI
48134-2764
US

IV. Provider business mailing address

2764 RIVERSIDE DR
TRENTON MI
48183-2809
US

V. Phone/Fax

Practice location:
  • Phone: 734-379-0781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101015906
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number5101015906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: