Provider Demographics
NPI:1396146932
Name:MICHAEL KALCICH EMERGENCY MEDICAL SERVICES CORPORATION
Entity type:Organization
Organization Name:MICHAEL KALCICH EMERGENCY MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOUND CARE/HBO PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VON
Authorized Official - Last Name:KALCICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-245-1453
Mailing Address - Street 1:432 HOLLOWDALE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3028
Mailing Address - Country:US
Mailing Address - Phone:405-340-5593
Mailing Address - Fax:405-340-5592
Practice Address - Street 1:3500 HEALTHPLEX PKWY
Practice Address - Street 2:#102
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9738
Practice Address - Country:US
Practice Address - Phone:405-307-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18986207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty