Provider Demographics
NPI:1205377975
Name:KALISZ, DAVID II (CNIM, REEGT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KALISZ
Suffix:II
Gender:M
Credentials:CNIM, REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 BEAVER RIDGE CIR STE D
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3833
Mailing Address - Country:US
Mailing Address - Phone:888-329-0807
Mailing Address - Fax:844-272-5852
Practice Address - Street 1:1880 BEAVER RIDGE CIRCLE SUITE D
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:888-329-0807
Practice Address - Fax:844-272-5842
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZE0600X246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic