Individual
MARK P KALLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 W CHISHOLM ST, ALPENA, MI 49707-1401
(989) 356-7390
(989) 356-7794
Mailing address
9750 US HIGHWAY 23 N, ALPENA, MI 49707-8948
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4301070855
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500401082
BCBS MICHIGAN
MI
05
—
4452025
—
MI
01
—
P00108478
MICHIGAN
MI
Enumeration date
10/13/2006
Last updated
09/07/2011
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