Provider Demographics
NPI:1003810417
Name:KALIEBE, OLGA (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:KALIEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE STE 105B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4049
Mailing Address - Country:US
Mailing Address - Phone:813-392-1900
Mailing Address - Fax:813-392-1901
Practice Address - Street 1:2919 W SWANN AVE STE 105B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4049
Practice Address - Country:US
Practice Address - Phone:813-392-1900
Practice Address - Fax:813-392-1901
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129394207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1055441Medicaid
BK8798285OtherFED DEA
LA4J223Medicare ID - Type Unspecified
LA1055441Medicaid