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General NPI Number Information
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NPI Number | 1831332279
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Entity Type | Individual
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Provider Name | SERGEI KALSOW MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 1501 KINGS HWY DEPARTMENT OF SURGERY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-675-6111
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Fax | 318-675-6141
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Provider Business Mailing Address
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Address Line | 137 SW 54TH TERRACE
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City | CAPE CORAL
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State | FL
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Zip | 33914
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Country | US
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Telephone | 352-246-1775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 284010
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License Number State | NY
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