Provider Demographics
NPI:1437772431
Name:KALIL, NATHAN JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JEFFREY
Last Name:KALIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COMMERCE PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9095
Mailing Address - Country:US
Mailing Address - Phone:194-832-4944
Mailing Address - Fax:
Practice Address - Street 1:102 COMMERCE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9095
Practice Address - Country:US
Practice Address - Phone:419-483-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.004108213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty