Provider Demographics
NPI:1003900903
Name:KALABAT, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KALABAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 W BIG BEAVER RD
Mailing Address - Street 2:STE D15
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3528
Mailing Address - Country:US
Mailing Address - Phone:248-649-8700
Mailing Address - Fax:
Practice Address - Street 1:1551 W BIG BEAVER RD
Practice Address - Street 2:STE D15
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3528
Practice Address - Country:US
Practice Address - Phone:248-649-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0634549Medicare ID - Type Unspecified
D43330Medicare UPIN