Provider Demographics
NPI:1033708714
Name:KALIS, ALAN MICHAEL
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MICHAEL
Last Name:KALIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:MICHAEL
Other - Last Name:KALISZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 CHARLES SPRING DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 CHARLES SPRING DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8216
Practice Address - Country:US
Practice Address - Phone:740-475-9364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107771Medicaid