Healthcare Provider Details

I. General information

NPI: 1568394062
Provider Name (Legal Business Name): KALLIE WEGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 SUNCREST DR
LAPEER MI
48446-1154
US

IV. Provider business mailing address

764 W FRANK ST
CARO MI
48723-1482
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-0500
  • Fax:
Mailing address:
  • Phone: 810-667-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: