=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194898346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID M MCKALIP MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 03/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1955 1ST AVENUE NORTH SUITE 101
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-8907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-822-3500
-----------------------------------------------------
Fax | 727-822-3228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1955 1ST AVENUE NORTH SUITE 101
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-8907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-822-3500
-----------------------------------------------------
Fax | 727-822-3228
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID MICHAEL MCKALIP
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-822-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | ME81052
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------