Provider Demographics
NPI:1457389769
Name:KALISZEWSKI, JON MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MARK
Last Name:KALISZEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:200 HEMLOCK M-55
Practice Address - Street 2:
Practice Address - City:TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48764
Practice Address - Country:US
Practice Address - Phone:989-362-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047034207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B43066Medicare UPIN
MI0350085Medicare ID - Type Unspecified