Healthcare Provider Details

I. General information

NPI: 1194904896
Provider Name (Legal Business Name): LAWRENCE J KALES D P M P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 STATE ROAD 52
HUDSON FL
34667-6708
US

IV. Provider business mailing address

7117 STATE ROAD 52
HUDSON FL
34667-6708
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-2128
  • Fax: 727-868-7491
Mailing address:
  • Phone: 727-868-2128
  • Fax: 727-868-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 1074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO 1074
License Number StateFL

VIII. Authorized Official

Name: DR. LAWRENCE J KALES
Title or Position: PRESIDENT
Credential: D P M P A
Phone: 727-868-2128