Provider Demographics
NPI:1558386474
Name:EMERGENCY PHYSICIANS OF MIDWEST CITY, LLC
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS OF MIDWEST CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KALCICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-485-4474
Mailing Address - Street 1:PO BOX 96408
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-6408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5004
Practice Address - Country:US
Practice Address - Phone:405-271-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746770AMedicaid
OK100746770AMedicaid