Provider Demographics
NPI:1497718878
Name:KALLIBJIAN, ARA E (DPM)
Entity Type:Individual
Prefix:DR
First Name:ARA
Middle Name:E
Last Name:KALLIBJIAN
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:P O BOX 74637
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4637
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:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-743-2525
Practice Address - Fax:440-743-2526
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002424213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0688377Medicaid
2700183OtherUNITEDHEALTHCARE
341687195027OtherCARESOURCE
000000167332OtherANTHEM
366732233011OtherMEDICAL MUTUAL
366732233011OtherMEDICAL MUTUAL
OHT80667Medicare UPIN