Provider Demographics
NPI:1912191685
Name:MACOMB COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MACOMB COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALKOFEN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MPH
Authorized Official - Phone:586-469-5512
Mailing Address - Street 1:43525 ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043
Mailing Address - Country:US
Mailing Address - Phone:586-469-5235
Mailing Address - Fax:586-469-5885
Practice Address - Street 1:27690 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2842
Practice Address - Country:US
Practice Address - Phone:586-465-9152
Practice Address - Fax:586-573-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No251K00000XAgenciesPublic Health or Welfare