Provider Demographics
NPI:1801958087
Name:KEITH J. KALISH DPM,PA
Entity type:Organization
Organization Name:KEITH J. KALISH DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KALISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-567-0111
Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4885
Mailing Address - Country:US
Mailing Address - Phone:772-567-0111
Mailing Address - Fax:772-567-7117
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4885
Practice Address - Country:US
Practice Address - Phone:772-567-0111
Practice Address - Fax:772-567-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO 001790OtherSTATE LIC#
FLPO 001790OtherSTATE LIC#