MEDICARE: JOEL P KALLAN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	ME11721	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1016232	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1447265038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL P KALLAN MD PA

Provider Business Mailing Address
First Line	:	1763 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1763 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:	305-858-6400
Fax Number	:	305-858-3233

Authorized Official
Title or Position	:	PRES
Name	:	JOEL KALLAN
Credential	:
Telephone Number	:	305-858-6400

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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