Healthcare Provider Details

I. General information

NPI: 1376618645
Provider Name (Legal Business Name): AYESHA KALEEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 NW 6TH PL STE A SUITE A
GAINESVILLE FL
32607-6116
US

IV. Provider business mailing address

4423 NW 6TH PLACE SUITE A
GAINESVILLE FL
32607-6115
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-5600
  • Fax: 352-377-0995
Mailing address:
  • Phone: 352-377-5600
  • Fax: 352-377-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME79639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: