Healthcare Provider Details

I. General information

NPI: 1326061664
Provider Name (Legal Business Name): BLAKE KALTURNYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DELMORE DR
ROSEAU MN
56751-1534
US

IV. Provider business mailing address

398 RIVER RD.
ST. ANDREWS MB
R1A2Y1
CA

V. Phone/Fax

Practice location:
  • Phone: 218-263-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38435
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: