Provider Demographics
NPI:1568464790
Name:KALIFEY, EDMOND (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:KALIFEY
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:P.O. BOX 97
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351
Mailing Address - Country:US
Mailing Address - Phone:504-258-8340
Mailing Address - Fax:318-409-4040
Practice Address - Street 1:137 DR. CHILDRESS DR.
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351
Practice Address - Country:US
Practice Address - Phone:318-256-3332
Practice Address - Fax:318-409-4040
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1062791Medicaid
LA1943681Medicaid
LA1062791Medicaid
LAP00078829Medicare PIN
LA290094YJBAMedicare PIN
B64047Medicare UPIN