Healthcare Provider Details

I. General information

NPI: 1497234272
Provider Name (Legal Business Name): MATTHEW JOHN KALB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 78TH AVE N STE 101
BROOKLYN PARK MN
55445-2719
US

IV. Provider business mailing address

101 W 2ND ST
DULUTH MN
55802-2086
US

V. Phone/Fax

Practice location:
  • Phone: 763-432-6875
  • Fax:
Mailing address:
  • Phone: 218-724-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: