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Organization
PINE TREES MEDICAL OFFICE PC
Active
Organization
PINE TREES MEDICAL OFFICE PC
Active
Other names
Mark A Kallus MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
ROY W BOYER MD (PRESIDENT)
(517) 688-4842
Entity
Organization
Contact information
Practice address
11610 WALDRON RD, JEROME, MI 49249-9637
(517) 688-4842
(517) 688-4842
Mailing address
11610 WALDRON RD, JEROME, MI 49249-9637
(517) 688-4842
(517) 688-4842
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301028315
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1 106914130
BCBS
MI
05
—
4462854
—
MI
01
—
P41335
BLUE CARE NETWORK HMO
MI
Enumeration date
09/07/2005
Last updated
08/22/2020
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