Healthcare Provider Details

I. General information

NPI: 1043486178
Provider Name (Legal Business Name): JAWAID KALIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST SUITE 400A
ERIE PA
16507-1427
US

IV. Provider business mailing address

300 STATE ST SUITE 400A
ERIE PA
16507-1427
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD434576
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: