PINE TREES MEDICAL OFFICE PC NPI 1487648374

NPI Information

NPI: 1487648374
Provider Name: PINE TREES MEDICAL OFFICE PC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Former Legal Business Name: MARK A KALLUS MD PC
Address: 11610 WALDRON RD
JEROME, MI
ZIP 49249
Phone: (517) 688-4842

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NPI Details

PINE TREES MEDICAL OFFICE PC is an internal medicine in Jerome, MI. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PINE TREES MEDICAL OFFICE PC NPI is 1487648374. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Mark A Kallus Md Pc.

The provider's business location address is:

11610 WALDRON RD
JEROME, MI
ZIP 49249-637
Phone: (517) 688-4842
Fax: (517) 688-4842

The provider's authorized official is Roy W Boyer .
The authorized official title is President and has the following contact phone number (517) 688-4842.

The enumeration date for this NPI number is 9/7/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		4301028315	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1 106914130	OTHER	MICHIGAN	BCBS
2	4462854	MEDICAID	MICHIGAN
3	P41335	OTHER	MICHIGAN	BLUE CARE NETWORK HMO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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