Provider Demographics
NPI:1972504397
Name:KALENIAN, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:KALENIAN
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 1:520 JOHN D. ODOM RD.
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9461
Mailing Address - Country:US
Mailing Address - Phone:334-794-2718
Mailing Address - Fax:334-671-1905
Practice Address - Street 1:520 JOHN D. ODOM RD.
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-9461
Practice Address - Country:US
Practice Address - Phone:334-794-2718
Practice Address - Fax:334-671-1905
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL16176207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051509093Medicaid
AL051509093Medicaid
ALF25945Medicare UPIN