Provider Demographics
NPI:1134539307
Name:KALIS, PERRY MICHAEL II (JD, MD, MA)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:MICHAEL
Last Name:KALIS
Suffix:II
Gender:M
Credentials:JD, MD, MA
Other - Prefix:DR
Other - First Name:P.
Other - Middle Name:MICHAEL
Other - Last Name:KALIS
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:JD, MD, MA
Mailing Address - Street 1:PO BOX 17668
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-469-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131530207R00000X, 207RH0002X
FLME138572207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101573800Medicaid