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General NPI Number Information
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NPI Number | 1295804367
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Entity Type | Organization
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Legal Business Name | KEITH J KALISH DPM PA
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 1285 36TH ST SUITE 203
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City | VERO BEACH
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State | FL
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Zip | 32960-4885
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Country | US
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Telephone | 772-567-0111
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Fax | 772-567-7117
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Provider Business Mailing Address
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Address Line | 2500 QUINCY AVE
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City | FORT PIERCE
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State | FL
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Zip | 34947-4766
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Country | US
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Telephone | 772-465-3207
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Fax | 772-465-3235
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | DR. KEITH JAY KALISH
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Credential | D P M
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Telephone | 772-465-3207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PO-001790
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License Number State | FL
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