Provider Demographics
NPI:1962498527
Name:KALIK, JOSEPH RANDY (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RANDY
Last Name:KALIK
Suffix:
Gender:M
Credentials:DO
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 1209
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0209
Mailing Address - Country:US
Mailing Address - Phone:724-347-5507
Mailing Address - Fax:724-347-6320
Practice Address - Street 1:295 N KERRWOOD DR
Practice Address - Street 2:SUITE #101
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5207
Practice Address - Country:US
Practice Address - Phone:724-347-5507
Practice Address - Fax:724-347-6320
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-09-19
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
PAOS007078E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52965Medicare UPIN