Provider Demographics
NPI:1477721462
Name:ARA E KALLIBJIAN
Entity Type:Organization
Organization Name:ARA E KALLIBJIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KALLIBJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-743-2525
Mailing Address - Street 1:6115 POWERS BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5469
Mailing Address - Country:US
Mailing Address - Phone:440-743-2525
Mailing Address - Fax:440-743-2526
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5469
Practice Address - Country:US
Practice Address - Phone:440-743-2525
Practice Address - Fax:440-743-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002424213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4910900001Medicare NSC