Provider Demographics
NPI:1396941001
Name:JACOB KALO MD PC
Entity type:Organization
Organization Name:JACOB KALO MD PC
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:313-526-3600
Mailing Address - Street 1:15650 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1444
Mailing Address - Country:US
Mailing Address - Phone:313-526-3600
Mailing Address - Fax:313-526-3603
Practice Address - Street 1:15650 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1444
Practice Address - Country:US
Practice Address - Phone:313-526-3600
Practice Address - Fax:313-526-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK040053174400000X
207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7820007OtherBLUE CROSS PIN
MI1703687Medicaid
MI1703687Medicaid
MIA77145Medicare UPIN