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NPI Code Detail

MEDICARE: KELLY E KALKOWSKI RT(R), MLT

MEDICARE: KELLY E KALKOWSKI RT(R), MLT
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
12471C3402XRadiography Radiologic Technologist344NE

General Provider Information

NPI Number : 1881727907
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY E KALKOWSKI RT(R), MLT
Provider Business Mailing Address
First Line : 110 S VISITING EAGLE ST
Second Line :
City : NIOBRARA
State : NE
Zip : 68760-7201
Country : US
Telephone Number : 402-857-2300
Fax Number : 402-857-2315
Provider Business Practice Location Address
First Line : 110 S VISITING EAGLE ST
Second Line :
City : NIOBRARA
State : NE
Zip : 68760-7201
Country : US
Telephone Number : 402-857-2300
Fax Number : 402-857-2315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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