MEDICARE: SERGE FREDRICK KALEVICH M.D.

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	207R00000X	Internal Medicine Physician	MA30720	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538151329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGE FREDRICK KALEVICH M.D.

Provider Business Mailing Address
First Line	:	1485 UNION VALLEY RD
Second Line	:	SUITE D
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-1336
Country	:	US
Telephone Number	:	973-728-1880
Fax Number	:	973-728-1559

Provider Business Practice Location Address
First Line	:	1485 UNION VALLEY RD
Second Line	:	SUITE D
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-1336
Country	:	US
Telephone Number	:	973-728-1880
Fax Number	:	973-728-1559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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