Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301004857 | MI |
NPI | 1215088422 |
---|---|
Provider Name | Dr. Thomas J Kalis |
First Address | Allen Park, MI 48101-1356 |
Second Address | Allen Park, MI 48101-1356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |