Provider Demographics
NPI:1437357787
Name:KALEMA, KIZITO
Entity Type:Individual
Prefix:MR
First Name:KIZITO
Middle Name:
Last Name:KALEMA
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 1:9024 VINCENT AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2154
Mailing Address - Country:US
Mailing Address - Phone:952-887-4162
Mailing Address - Fax:
Practice Address - Street 1:8925 ZANZIBAR LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1249
Practice Address - Country:US
Practice Address - Phone:763-670-3715
Practice Address - Fax:763-494-3715
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant