Provider Demographics
NPI:1689776577
Name:CALLAWAY, KELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3380 BEECHER RD
Mailing Address - Street 2:STE C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3647
Mailing Address - Country:US
Mailing Address - Phone:810-732-0944
Mailing Address - Fax:810-732-2030
Practice Address - Street 1:G3380 BEECHER RD
Practice Address - Street 2:SUITE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3647
Practice Address - Country:US
Practice Address - Phone:810-732-0944
Practice Address - Fax:810-732-2030
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4084930Medicaid
MIE38038Medicare UPIN
MI4084930Medicaid