Individual
KERRY M KALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
166 19TH STREET SOUTH, SUITE 100, SARTELL, MN 56377-2154
(320) 251-0609
(320) 251-3806
Mailing address
PO BOX 1450 NW 6035, MINNEAPOLIS, MN 55485-6035
(952) 542-8553
(952) 513-6857
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
40558
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
979669000
—
MN
Enumeration date
03/01/2006
Last updated
02/15/2012
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