MEDICARE: DR. JASON MICHAEL KALK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	R71128	NY
2	213E00000X	Podiatrist	SC006242	PA
3	213ES0103X	Foot & Ankle Surgery Podiatrist	016.005508	IL

General Provider Information

NPI Number	:	1427331347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MICHAEL KALK DPM

Provider Business Mailing Address
First Line	:	4211 N CICERO AVE STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	773-202-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 N CICERO AVE STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	773-202-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	10/30/2020

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