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General NPI Number Information
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NPI Number | 1427331347
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Entity Type | Individual
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Provider Name | JASON MICHAEL KALK DPM
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Gender | Male
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 4211 N CICERO AVE STE 301
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City | CHICAGO
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State | IL
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Zip | 60641-1649
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Country | US
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Telephone | 773-202-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 N CICERO AVE STE 301
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City | CHICAGO
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State | IL
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Zip | 60641-1649
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Country | US
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Telephone | 773-202-8800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | R71128
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC006242
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016.005508
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License Number State | IL
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