Healthcare Provider Details

I. General information

NPI: 1962475459
Provider Name (Legal Business Name): MICHAEL KALSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 R C HOAG DR
SALAMANCA NY
14779-1365
US

IV. Provider business mailing address

PO BOX 10386
ALBANY NY
12201-5386
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-5894
  • Fax:
Mailing address:
  • Phone: 716-945-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number214568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: