Provider Demographics
NPI:1851905988
Name:KALCZUK, AIMEE RAE (MS, RD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:RAE
Last Name:KALCZUK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 TRINIDAD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7701
Mailing Address - Country:US
Mailing Address - Phone:616-970-5177
Mailing Address - Fax:
Practice Address - Street 1:1507 TRINIDAD AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-7701
Practice Address - Country:US
Practice Address - Phone:616-970-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86079179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered