Provider Demographics
NPI:1528218971
Name:DE JESUS KALIL, CLARA L (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:L
Last Name:DE JESUS KALIL
Suffix:
Gender:F
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:PO BOX 770719
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-0719
Mailing Address - Country:US
Mailing Address - Phone:352-873-4458
Mailing Address - Fax:352-873-8116
Practice Address - Street 1:7860 SW 103RD ST. RD.
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8623
Practice Address - Country:US
Practice Address - Phone:352-873-4458
Practice Address - Fax:352-873-8116
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN812208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIT897ZMedicare UPIN