Provider Demographics
NPI:1972849842
Name:JACOB KALO, M.D., P.C.
Entity Type:Organization
Organization Name:JACOB KALO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-751-7070
Mailing Address - Street 1:11474 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3810
Mailing Address - Country:US
Mailing Address - Phone:586-979-2341
Mailing Address - Fax:586-979-2269
Practice Address - Street 1:11474 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3810
Practice Address - Country:US
Practice Address - Phone:586-979-2341
Practice Address - Fax:586-979-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK040053174400000X
207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty