Provider Demographics
NPI:1538235155
Name:EDLEMAN, JOHN KALLMAN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KALLMAN
Last Name:EDLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-9679
Mailing Address - Country:US
Mailing Address - Phone:231-533-8586
Mailing Address - Fax:231-533-4463
Practice Address - Street 1:7033 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9679
Practice Address - Country:US
Practice Address - Phone:231-533-8586
Practice Address - Fax:231-533-4463
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101005147Medicaid
E26057Medicare UPIN