Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO-001790 | FL |
NPI | 1023124609 |
---|---|
Provider Name | Dr. Keith Jay Kalish |
First Address | Vero Beach, FL 32960-6588 |
Second Address | Vero Beach, FL 32960-6588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 11/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55634 | (02) | FL |