Healthcare Provider Details

I. General information

NPI: 1720320245
Provider Name (Legal Business Name): JEFFREY S KALM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SEVILLE RD
SAGINAW MN
55779-9796
US

IV. Provider business mailing address

6601 SEVILLE RD
SAGINAW MN
55779-9796
US

V. Phone/Fax

Practice location:
  • Phone: 218-348-1598
  • Fax:
Mailing address:
  • Phone: 218-348-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 175808 9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: