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Individual

KATHY MARIE KALLMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1320 MERCY DR NW, CANTON, OH 44708-2614
(330) 489-1055
Mailing address
1889 BASSWOOD DR, KENT, OH 44240-4286

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35074441K
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2102110
OH
01
930077063
MEDICARE RR-GA
OH
01
942460636375
CARESOURCE
OH
Enumeration date
06/10/2006
Last updated
01/05/2009
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