Provider Demographics
NPI:1124127345
Name:KALUCIS, CHRIS JOHN (DO)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:JOHN
Last Name:KALUCIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25761 LORAIN RD
Mailing Address - Street 2:3RD FL
Mailing Address - City:N OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-779-1112
Mailing Address - Fax:440-779-0247
Practice Address - Street 1:15299 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4823
Practice Address - Country:US
Practice Address - Phone:440-234-5150
Practice Address - Fax:440-234-9138
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005019207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH040013530OtherMEDICARE RAILROAD
OH0125411Medicaid
OH0125411Medicaid
OHKA0787493Medicare PIN