Provider Demographics
NPI:1023124609
Name:KALISH, KEITH JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAY
Last Name:KALISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6588
Mailing Address - Country:US
Mailing Address - Phone:772-567-0111
Mailing Address - Fax:772-567-7117
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:STE 203
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6588
Practice Address - Country:US
Practice Address - Phone:772-567-0111
Practice Address - Fax:772-567-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-001790213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87984XMedicare PIN
FLT55634Medicare UPIN