Individual
JOHN R KALLIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
155
WI
363AS0400X
Surgical Physician Assistant
2368
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42917600
—
WI
Enumeration date
06/22/2005
Last updated
10/24/2013
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