MEDICARE: MR. JOEL PACE KALLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	0011721FL	FL
2	207X00000X	Orthopaedic Surgery Physician	0011721	FL
3	207X00000X	Orthopaedic Surgery Physician	ME11721	FL

General Provider Information

NPI Number	:	1326035965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL PACE KALLAN MD

Provider Business Mailing Address
First Line	:	311 LOS PINOS PLACE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143
Country	:	US
Telephone Number	:	305-318-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 LOS PINOS PLACE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143
Country	:	US
Telephone Number	:	305-318-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	02/18/2020

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