Provider Demographics
NPI:1679676258
Name:KALICHMAN, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:KALICHMAN
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 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5092
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:
Practice Address - Street 1:560 GAGE BLVD STE 101
Practice Address - Street 2:KADLEC CLINIC SOUTH RICHLAND PRIMARY CARE
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9531
Practice Address - Country:US
Practice Address - Phone:509-628-2843
Practice Address - Fax:509-628-3843
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83342Medicare UPIN