Healthcare Provider Details

I. General information

NPI: 1972504397
Provider Name (Legal Business Name): MARK H. KALENIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 JOHN D. ODOM RD.
DOTHAN AL
36303-9461
US

IV. Provider business mailing address

520 JOHN D. ODOM RD.
DOTHAN AL
36303-9461
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-2718
  • Fax: 334-671-1905
Mailing address:
  • Phone: 334-794-2718
  • Fax: 334-671-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberAL16176
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: