Healthcare Provider Details

I. General information

NPI: 1275075228
Provider Name (Legal Business Name): KALICO PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S AUSTIN AVE STE 1320
GEORGETOWN TX
78626-5637
US

IV. Provider business mailing address

501 S AUSTIN AVE STE 1320
GEORGETOWN TX
78626-5637
US

V. Phone/Fax

Practice location:
  • Phone: 888-798-9843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CHOI
Title or Position: OWNER
Credential:
Phone: 888-789-9843