Provider Demographics
NPI:1225015191
Name:KALT, JEFFREY C (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:KALT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30301 WOODWARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0981
Mailing Address - Country:US
Mailing Address - Phone:248-398-2525
Mailing Address - Fax:248-398-9286
Practice Address - Street 1:30301 WOODWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0981
Practice Address - Country:US
Practice Address - Phone:248-398-2525
Practice Address - Fax:248-398-9286
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0308390001OtherADMINASTAR
180023697OtherRAILROAD MEDICARE
180F375320OtherBLUE CARE NETWORK
MI180F375320OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
0004237942OtherAETNA
MI3117704Medicaid
4237942OtherDETROIT MEDICAL CENTER
C3069OtherMCARE
101836OtherGREAT LAKES
E89376OtherHAP
E89376OtherHAP
E89376Medicare UPIN