Provider Demographics
NPI:1164183877
Name:KALASHO, JOVIAN
Entity Type:Individual
Prefix:
First Name:JOVIAN
Middle Name:
Last Name:KALASHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1915
Mailing Address - Country:US
Mailing Address - Phone:248-825-6637
Mailing Address - Fax:
Practice Address - Street 1:4038 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1915
Practice Address - Country:US
Practice Address - Phone:248-825-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide