Provider Demographics
NPI:1639607344
Name:KALCEC, EVERETT RUSSELL (DO)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:RUSSELL
Last Name:KALCEC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:EVERETT
Other - Middle Name:RUSSELL
Other - Last Name:KALCEC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-205-3998
Mailing Address - Fax:
Practice Address - Street 1:501 STATE ST N
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2811
Practice Address - Country:US
Practice Address - Phone:507-835-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66796207Q00000X, 207Q00000X
MI5101024628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine