Provider Demographics
NPI:1497739551
Name:KALSKI, RICHARD STEWART (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEWART
Last Name:KALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SW 97TH AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1494
Mailing Address - Country:US
Mailing Address - Phone:305-665-2023
Mailing Address - Fax:305-665-2363
Practice Address - Street 1:6161 SUNSET DR
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5045
Practice Address - Country:US
Practice Address - Phone:305-665-2023
Practice Address - Fax:305-665-2363
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67050207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259511700Medicaid
FL259511700Medicaid
FLF82808Medicare UPIN