Provider Demographics
NPI:1043875776
Name:DEAM, KALEB T (DO)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:T
Last Name:DEAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:225 STOCKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5511
Mailing Address - Country:US
Mailing Address - Phone:937-644-2070
Mailing Address - Fax:937-644-0105
Practice Address - Street 1:225 STOCKSDALE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5511
Practice Address - Country:US
Practice Address - Phone:937-644-2070
Practice Address - Fax:937-644-0105
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.015437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468419Medicaid