Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02005503A | IN |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101019060 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 02005503A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 5101019060 | MI |
N | 2081P2900X | Pain Medicine | 02005503A | IN |
N | 2081P2900X | Pain Medicine | 5101019060 | MI |
N | 2081S0010X | Sports Medicine | 02005503A | IN |
N | 213ES0000X | Sports Medicine | 02005503A | IN |
N | 2081S0010X | Sports Medicine | 5101019060 | MI |
N | 213ES0000X | Sports Medicine | 5101019060 | MI |
N | 225400000X | Rehabilitation Practitioner | 5101019060 | MI |
NPI | 1154613131 |
---|---|
Provider Name | Dr. George Steven Kalesperis |
First Address | Fortville, IN 46040-9225 |
Second Address | Fortville, IN 46040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2011 |
Last Update Date | 22/01/2019 |