Provider Demographics
NPI:1225015191
Name:KALT, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:KALT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072
Mailing Address - Country:US
Mailing Address - Phone:248-398-2525
Mailing Address - Fax:248-398-9286
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:STE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072
Practice Address - Country:US
Practice Address - Phone:248-398-2525
Practice Address - Fax:248-398-9286
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180F375320OtherBLUE CARE NETWORK
4237942OtherDETROIT MEDICAL CENTER
E89376OtherHAP
MI3117704Medicaid
180023697OtherRAILROAD MEDICARE
0004237942OtherAETNA
101836OtherGREAT LAKES
MI180F375320OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
0308390001OtherADMINASTAR
C3069OtherMCARE
E89376OtherHAP
E89376Medicare UPIN