Healthcare Provider Details

I. General information

NPI: 1003179730
Provider Name (Legal Business Name): KALEN JACOB RIMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W MICHIGAN AVE
JACKSON MI
49201-1900
US

IV. Provider business mailing address

744 W MICHIGAN AVE
JACKSON MI
49201-1900
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2146
  • Fax:
Mailing address:
  • Phone: 517-205-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301114132
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: