Organization
KEITH J. KALISH DPM, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH JAY KALISH DPM (OWNER)
(772) 465-3207
Entity
Organization
Contact information
Practice address
2500 QUINCY AVE, FORT PIERCE, FL 34947-4766
(772) 465-3207
(772) 465-3235
Mailing address
2500 QUINCY AVE, FORT PIERCE, FL 34947-4766
(772) 465-3207
(772) 465-3235
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PO 001790
STATE LIC#
FL
Enumeration date
12/11/2006
Last updated
08/22/2020
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