Active NPI
Brad Kalleberg, RT (R)
- Radiologic Technologist
- Livonia, MI
National Provider Identifier
1295125409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- 471704
- Practice address
- 38777 6 Mile Rd
Livonia, MI 48152-2694 - Phone
- (734) 452-0395
- Fax
- (877) 414-9925
- NPI assigned
- Jan 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 471704 | MN | Primary |
Addresses
Primary practice location
38777 6 Mile Rd
Livonia, MI 48152-2694
Mailing address
38777 6 Mile Rd
Livonia, MI 48152-2694
Phone (734) 452-0395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 471704 | MN | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1295125409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38777 6 MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522694",
"telephone_number": "734-452-0395",
"fax_number": "877-414-9925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38777 6 MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522694",
"telephone_number": "734-452-0395",
"fax_number": "877-414-9925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLEBERG",
"first_name": "BRAD",
"credential": "RT (R)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-26",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "MN",
"license": "471704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.