Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301114132 | MI |
NPI | 1003179730 |
---|---|
Provider Name | Dr. Kalen Jacob Rimar |
First Address | Jackson, MI 49201-1900 |
Second Address | Jackson, MI 49201-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 15/12/2020 |