Provider Demographics
NPI:1336497809
Name:KALISH, DANIEL A
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:KALISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 FAKE ST
Mailing Address - Street 2:
Mailing Address - City:IMAGINATION LAND
Mailing Address - State:AK
Mailing Address - Zip Code:77777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 FAKE ST
Practice Address - Street 2:
Practice Address - City:IMAGINATION LAND
Practice Address - State:AK
Practice Address - Zip Code:77777
Practice Address - Country:US
Practice Address - Phone:777-777-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80450237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist