Provider Demographics
NPI:1326099524
Name:KALAHER, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KALAHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:1934 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-1910
Practice Address - Country:US
Practice Address - Phone:618-565-1406
Practice Address - Fax:618-565-1407
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8247OtherEYEMED
IL046008247Medicaid
234784OtherHARMONY HEALTH PLAN
IL0814870007OtherMEDICARE NSC NUMBER
IL0814870021OtherMEDICARE NSC NUMBER
IL410049822, CA2196OtherMEDICARE RAILROAD
081898OtherHEALTH ALLIANCE
ILL96653Medicare PIN
ILU26676Medicare UPIN