Provider Demographics
NPI:1487966933
Name:KALBAC, BETH FORSTER (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:FORSTER
Last Name:KALBAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15404 SW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2496
Mailing Address - Country:US
Mailing Address - Phone:305-926-3060
Mailing Address - Fax:
Practice Address - Street 1:8750 SW 144TH ST
Practice Address - Street 2:SUITE #100
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7296
Practice Address - Country:US
Practice Address - Phone:305-253-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062577208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics