Provider Demographics
NPI:1699262006
Name:AFFILIATED KNEE PAIN SPECIALISTS, PLLC
Entity type:Organization
Organization Name:AFFILIATED KNEE PAIN SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KALLABAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-7085
Mailing Address - Street 1:45445 MOUND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5178
Mailing Address - Country:US
Mailing Address - Phone:866-207-5105
Mailing Address - Fax:
Practice Address - Street 1:31333 SOUTHFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5473
Practice Address - Country:US
Practice Address - Phone:248-952-9190
Practice Address - Fax:248-952-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070138207R00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty