Individual
MARK A KALT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5260
Mailing address
7 W SQUARE LAKE RD, BLOOMFIELD HILLS, MI 48302-0462
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101010586
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0555021645
BCBS
MI
05
—
2973453-11
—
MI
05
—
3405058-11
—
MI
Enumeration date
06/13/2006
Last updated
07/08/2007
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