Healthcare Provider Details

I. General information

NPI: 1982733259
Provider Name (Legal Business Name): DR. HANIT KALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 DEQUINDRE RD SUITE 222
TROY MI
48085-1128
US

IV. Provider business mailing address

44199 DEQUINDRE RD SUITE 222
TROY MI
48085-1128
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-5570
  • Fax: 248-879-2235
Mailing address:
  • Phone: 248-879-5570
  • Fax: 248-879-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301087242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: