Provider Demographics
NPI:1588740385
Name:KALUS, ROBERT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
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 1:6113 24TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7023
Mailing Address - Country:US
Mailing Address - Phone:206-632-2505
Mailing Address - Fax:206-368-1503
Practice Address - Street 1:1550 N 115TH ST
Practice Address - Street 2:D-149B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8401
Practice Address - Country:US
Practice Address - Phone:206-368-1500
Practice Address - Fax:206-368-1503
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039956207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110237174OtherRAIL ROAD MEDICARE
310OtherINTERNAL ID-MOTOR VEHICLE ID
WA8320764Medicaid
H62163Medicare UPIN
WAG8891813Medicare PIN
WA110237174OtherRAIL ROAD MEDICARE
AB29263Medicare ID - Type Unspecified