Individual
GERALD J. KALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1437 N SUMMIT AVE, OCONOMOWOC, WI 53066-9461
(414) 322-1434
Mailing address
1437 N SUMMIT AVE, OCONOMOWOC, WI 53066-9461
(414) 322-1434
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14655-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14655-20
—
WI
Enumeration date
08/17/2015
Last updated
08/17/2015
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