Healthcare Provider Details

I. General information

NPI: 1639179203
Provider Name (Legal Business Name): ANDRZEJ EDWARD KALINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 EBENEZER RD
ROCK HILL SC
29732-2353
US

IV. Provider business mailing address

1243 EBENEZER RD
ROCK HILL SC
29732-2353
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-9393
  • Fax: 803-366-9396
Mailing address:
  • Phone: 803-366-9393
  • Fax: 803-366-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number22-17182
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: