MEDICARE: MICHAEL A. KALATA D.O.

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	207RC0000X	Cardiovascular Disease Physician	5101015906	MI
2	246X00000X	Cardiovascular Specialist/Technologist	5101015906	MI

General Provider Information

NPI Number	:	1972707602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A. KALATA D.O.

Provider Business Mailing Address
First Line	:	2764 RIVERSIDE DR
Second Line	:
City	:	TRENTON
State	:	MI
Zip	:	48183-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29100 GATEWAY BLVD
Second Line	:	SUITE 300
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-2764
Country	:	US
Telephone Number	:	734-379-0781
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	06/06/2017

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