Individual
JEREMY KALLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24681 NORTHWESTERN HWY, STE. 100, SOUTHFIELD, MI 48075-2305
(248) 352-2000
(248) 324-1477
Mailing address
24681 NORTHWESTERN HWY, STE. 100, SOUTHFIELD, MI 48075-2305
(248) 352-2000
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301063038
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4403817
—
MI
Enumeration date
01/18/2006
Last updated
09/05/2007
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