Individual
DR. KALI ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
701 PARK AVE, LAKE PARK, FL 33403-2503
(561) 848-7722
(561) 848-7812
Mailing address
11380 PROSPERITY FARMS RD STE 221E, PALM BEACH GARDENS, FL 33410-3465
(561) 848-7722
(561) 848-7812
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO3255
FL
213E00000X
Podiatrist
POD001044
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PO3255
STATE LICENSE
FL
01
—
POD001044
STATE LICENSE
GA
Enumeration date
08/02/2006
Last updated
03/07/2023
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