Provider Demographics
NPI:1942839980
Name:KLALLANDO PC
Entity Type:Organization
Organization Name:KLALLANDO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-472-4052
Mailing Address - Street 1:5174 ROYCE RD
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48892-9760
Mailing Address - Country:US
Mailing Address - Phone:858-472-4052
Mailing Address - Fax:
Practice Address - Street 1:4830 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2089
Practice Address - Country:US
Practice Address - Phone:517-721-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty