Provider Demographics
NPI:1538132030
Name:KALIFE, GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:KALIFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:
Other - Last Name:KALIFE-CANAVATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 SETON PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-8002
Mailing Address - Country:US
Mailing Address - Phone:512-324-4812
Mailing Address - Fax:512-324-4728
Practice Address - Street 1:1 MERCADO ST STE 130
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:970-247-1128
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3768207RI0011X
COCDR.0003186207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047584008Medicaid
TX8CN859OtherBCBS ID
TX047584007Medicaid
TX047584007Medicaid
TXTXB117165Medicare PIN