Provider Demographics
NPI:1700099421
Name:ADEL A KALLINI MD PA
Entity Type:Organization
Organization Name:ADEL A KALLINI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:AYAD
Authorized Official - Last Name:KALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-788-9003
Mailing Address - Street 1:440 EAST SAMPLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-788-9003
Mailing Address - Fax:954-788-9631
Practice Address - Street 1:440 EAST SAMPLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-788-9003
Practice Address - Fax:954-788-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032795207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2674769-00Medicaid
FLK3217Medicare UPIN
FL93761ZMedicare ID - Type Unspecified