Provider Demographics
NPI:1407150915
Name:PAUL J KALIN
Entity Type:Organization
Organization Name:PAUL J KALIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-1238
Mailing Address - Street 1:1013 MAR WALT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6723
Mailing Address - Country:US
Mailing Address - Phone:850-863-1238
Mailing Address - Fax:850-864-3338
Practice Address - Street 1:1013 MAR WALT DR
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6723
Practice Address - Country:US
Practice Address - Phone:850-863-1238
Practice Address - Fax:850-864-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029694500Medicaid
FL029694500Medicaid