MEDICARE: PERRY KALIS M.D. INC

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	35038121K	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	210780	OTHER	OH	NATIONWIDE INSURANCE
2	0404062	OTHER	OH	UNITED HEALTHCARE
3	235727435003	OTHER	OH	MEDICAL MUTUAL
4	000000122256	OTHER	OH	ANTHEM INDIVIDUAL
5	000000162736	OTHER	OH	ANTHEM-GROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	000000217078	OTHER	OH	ANTHEM-LAB
8	6952646002	OTHER	OH	CIGNA
9	23572743500	OTHER	OH	BWC
10	M38121A	OTHER	OH	HEALTH PLAN

General Provider Information

NPI Number	:	1902979453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY KALIS M.D. INC

Provider Business Mailing Address
First Line	:	129 NORTH MAYSVILLE AVE
Second Line	:	SUITE B
City	:	SOUTH ZANESVILLE
State	:	OH
Zip	:	43701-7507
Country	:	US
Telephone Number	:	740-588-0008
Fax Number	:	740-588-0143

Provider Business Practice Location Address
First Line	:	129 NORTH MAYSVILLE AVENUE
Second Line	:	SUITE B
City	:	SOUTH ZANESVILLE
State	:	OH
Zip	:	43701
Country	:	US
Telephone Number	:	740-588-0008
Fax Number	:	740-588-0143

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PERRY M KALIS
Credential	:	M.D.
Telephone Number	:	740-588-0008

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/30/2008

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