NPIMap

Individual provider Active NPI

Kalub Alexander Fedak, M.D.

  • Hematology & Oncology Physician
  • Petoskey, MI
National Provider Identifier
1225353139
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
4301104179 Issued in MI
Practice address
560 W Mitchell St Ste 185
Petoskey, MI 49770-2296
Phone
(231) 487-3390
Fax
(231) 487-3578
NPI assigned
Apr 2, 2010
Last updated
Sep 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301104179 MI
Hematology & Oncology Physician 207RH0003X 4301104179 MI Primary

Addresses

Primary practice location

560 W Mitchell St Ste 185
Petoskey, MI 49770-2296

Mailing address

560 W Mitchell St Ste 185
Petoskey, MI 49770-2296
Phone (231) 487-3390

Other identifiers 1

IdentifierTypeStateIssuer
1225353139OtherMINPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131111001439 MI Practitioner - Hematology/OncologyPractitioner - Internal MedicinePractitioner - Hospitalist 1850527375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Michigan State University College of Human Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
McLaren Northern MichiganGroup PAC ID 9931018181, 60 clinicians
McLaren Central MichiganGroup PAC ID 6103733092, 183 clinicians

Practice addresses (Care Compare)

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-4000

560 W Mitchell St
Suite 185
Petoskey, MI 49770-2296
Phone (231) 487-3295

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Central Michigan Current Accepting new patients
McLaren Northern Michigan CurrentSince May 16, 2023 Accepting new patients
McLaren Central Michigan CurrentSince Aug 1, 2022 Accepting new patients
McLaren Northern Michigan CurrentSince May 16, 2023 Accepting new patients
McLaren Central Michigan CurrentSince Aug 1, 2022 Accepting new patients
McLaren Central Michigan Past Accepting new patients

Locations

918 N Center Ave
Gaylord, MI 49735
Phone (231) 487-3610

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

2390 Mitchell Park Dr
Ste D
Petoskey, MI 49770
Phone (231) 242-1760

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

560 W Mitchell St
Ste 170
Petoskey, MI 49770
Phone (231) 487-3217

560 W Mitchell St
Ste 185
Petoskey, MI 49770
Phone (231) 487-3217

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1225353139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST STE 185",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702296",
            "telephone_number": "231-487-3390",
            "fax_number": "314-873-5782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST STE 185",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702296",
            "telephone_number": "231-487-3390",
            "fax_number": "231-487-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDAK",
        "first_name": "KALUB",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-02",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301104179",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "4301104179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1225353139",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.