Provider Demographics
NPI:1851405088
Name:KALIVAS, RISTY (DO)
Entity Type:Individual
Prefix:DR
First Name:RISTY
Middle Name:
Last Name:KALIVAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-6122
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:900 COOPER
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:989-583-6122
Practice Address - Fax:989-583-2811
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3482718Medicaid
MI3482718Medicaid
MIM654100011Medicare ID - Type Unspecified