Healthcare Provider Details

I. General information

NPI: 1659577351
Provider Name (Legal Business Name): JACOB KALO, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6765 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3422
US

IV. Provider business mailing address

6765 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3422
US

V. Phone/Fax

Practice location:
  • Phone: 248-932-1777
  • Fax: 248-932-1888
Mailing address:
  • Phone: 248-932-1777
  • Fax: 248-932-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJK040053
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB KALO
Title or Position: OWNER
Credential: M.D.
Phone: 248-932-1777