Healthcare Provider Details

I. General information

NPI: 1043230733
Provider Name (Legal Business Name): JOHN C. KAIRYS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST SUITE 500
PHILADELPHIA PA
19107-5563
US

IV. Provider business mailing address

1100 WALNUT ST SUITE 500
PHILADELPHIA PA
19107-5563
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-5528
  • Fax: 215-503-8505
Mailing address:
  • Phone: 215-955-8666
  • Fax: 215-503-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD042657L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: