Provider Demographics
NPI:1366422016
Name:KALIK, CRAIG ANDREW (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANDREW
Last Name:KALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6305
Mailing Address - Country:US
Mailing Address - Phone:813-681-6537
Mailing Address - Fax:813-661-3227
Practice Address - Street 1:3658 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-6305
Practice Address - Country:US
Practice Address - Phone:813-681-6537
Practice Address - Fax:813-661-3227
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056740207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAETNAOther4314479
FL1169602009OtherCIGNA
FL18750OtherBCBS
FL372713100Medicaid
FL0205356OtherUNITED HEALTHCARE
FLAVMEDOther256659
FL0205356OtherUNITED HEALTHCARE
FL1169602009OtherCIGNA