Provider Demographics
NPI:1639190382
Name:MYMICHIGAN MEDICAL CENTER SAULT
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER SAULT
Other - Org Name:WMH ER PROFESSIONAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-635-4456
Mailing Address - Street 1:500 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1822
Mailing Address - Country:US
Mailing Address - Phone:906-635-4460
Mailing Address - Fax:
Practice Address - Street 1:500 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1822
Practice Address - Country:US
Practice Address - Phone:906-635-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170020207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700A710540OtherBCBSMI MD GROUP #
MI500A710570OtherBCBSMI NP GROUP #
CA5300Medicare PIN
MI500A710570OtherBCBSMI NP GROUP #