Basic Information
| Provider Information | |||||||||
| NPI: | 1396146932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL KALCICH EMERGENCY MEDICAL SERVICES CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 432 HOLLOWDALE | ||||||||
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| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730033028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053405593 | ||||||||
| FaxNumber: | 4053405592 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 HEALTHPLEX PKWY | ||||||||
| Address2: | #102 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730729738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053076955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | KALCICH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | VON | ||||||||
| AuthorizedOfficialTitleorPosition: | WOUND CARE/HBO PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4052451453 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | 18986 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No ID Information.