Provider Demographics
NPI:1932227873
Name:INTERNAL MEDICINE AND PEDIATRICS OF BLOOMFIELD PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND PEDIATRICS OF BLOOMFIELD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLABAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-723-2400
Mailing Address - Street 1:1109 W LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1964
Mailing Address - Country:US
Mailing Address - Phone:248-723-2400
Mailing Address - Fax:
Practice Address - Street 1:1109 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1964
Practice Address - Country:US
Practice Address - Phone:248-723-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
MI208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty