Healthcare Provider Details

I. General information

NPI: 1629459904
Provider Name (Legal Business Name): DAMIAN KALISIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 E MAPLE RD
TROY MI
48083-6106
US

IV. Provider business mailing address

2891 E MAPLE RD STE 102
TROY MI
48083-6106
US

V. Phone/Fax

Practice location:
  • Phone: 248-524-9085
  • Fax: 248-524-9086
Mailing address:
  • Phone: 248-524-9085
  • Fax: 248-524-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1.060415
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: