MEDICARE: ROBERT L KALEZ MD PC

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	208800000X	Urology Physician	006014	OR

General Provider Information

NPI Number	:	1710110127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L KALEZ MD PC

Provider Business Mailing Address
First Line	:	24900 SE STARK ST
Second Line	:	208
City	:	GRESHAM
State	:	OR
Zip	:	97030-3355
Country	:	US
Telephone Number	:	503-666-3030
Fax Number	:	503-666-3434

Provider Business Practice Location Address
First Line	:	24900 SE STARK ST
Second Line	:	208
City	:	GRESHAM
State	:	OR
Zip	:	97030-3355
Country	:	US
Telephone Number	:	503-666-3030
Fax Number	:	503-666-3434

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT L KALEZ
Credential	:	M.D.
Telephone Number	:	503-666-3030

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	11/02/2009

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