Provider Demographics
NPI:1609955145
Name:CALISE, DOMENICK ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:DOMENICK
Middle Name:ANTHONY
Last Name:CALISE
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 1:6326 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2531
Mailing Address - Country:US
Mailing Address - Phone:813-788-3600
Mailing Address - Fax:813-788-7010
Practice Address - Street 1:6326 FORT KING RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2531
Practice Address - Country:US
Practice Address - Phone:813-788-3600
Practice Address - Fax:813-788-7010
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3744213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3744OtherLICENSE
NYRA9179Medicare PIN
FLPO3744OtherLICENSE
NYT51491Medicare UPIN