Healthcare Provider Details

I. General information

NPI: 1093706640
Provider Name (Legal Business Name): JOHN JOSEPH KALENKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 NORTH MACOMB STREET SUITE 400
MONROE MI
48162-2904
US

IV. Provider business mailing address

730 NORTH MACOMB STREET SUITE 400
MONROE MI
48162-2904
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-6499
  • Fax: 734-242-8992
Mailing address:
  • Phone: 734-242-6499
  • Fax: 734-242-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMI4301050330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: