Provider Demographics
NPI:1437211802
Name:KEITH J KALISH DPM PA
Entity Type:Organization
Organization Name:KEITH J KALISH DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KALISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-567-0111
Mailing Address - Street 1:1285 36TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6588
Mailing Address - Country:US
Mailing Address - Phone:772-567-0111
Mailing Address - Fax:772-257-6521
Practice Address - Street 1:1285 36TH ST STE 203
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6588
Practice Address - Country:US
Practice Address - Phone:772-567-0111
Practice Address - Fax:772-257-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-001790213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO-001790OtherSTATE LIC#
FL5803780001Medicare NSC
FLPO-001790OtherSTATE LIC#
FLAA987Medicare PIN