Provider Demographics
NPI:1003348210
Name:THEIS, KALI (DO)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:THEIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:
Other - Last Name:ALVARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 EXCELA HEALTH DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-539-6353
Mailing Address - Fax:724-539-6353
Practice Address - Street 1:100 EXCELA HEALTH DR STE 301
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-537-1480
Practice Address - Fax:724-539-6353
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4327208000000X
PAOS020468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics