Provider Demographics
NPI:1992796890
Name:KALUS, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KALUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WARRENSVILLE HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-921-1600
Mailing Address - Fax:216-491-0707
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 403
Practice Address - City:WARRENSVILLE HTS.
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-921-1600
Practice Address - Fax:216-491-0707
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052883207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0698204Medicaid
OH0698204Medicaid
A17406Medicare UPIN