Healthcare Provider Details

I. General information

NPI: 1699870634
Provider Name (Legal Business Name): DANIEL G KALBAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 SUNSET DR SUITE 201
SOUTH MIAMI FL
33143-4529
US

IV. Provider business mailing address

PO BOX 430430
SOUTH MIAMI FL
33243-0430
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-7601
  • Fax: 305-661-0154
Mailing address:
  • Phone: 305-661-7601
  • Fax: 305-661-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME58988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME58988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: