Healthcare Provider Details

I. General information

NPI: 1649265448
Provider Name (Legal Business Name): STEVE B KALISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE SUITE 214
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

2740 W FOSTER AVE SUITE 214
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-3400
  • Fax: 773-506-2668
Mailing address:
  • Phone: 773-907-3400
  • Fax: 773-506-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-058467
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: