Provider Demographics
NPI:1194904896
Name:LAWRENCE J KALES D P M P A
Entity type:Organization
Organization Name:LAWRENCE J KALES D P M P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALES
Authorized Official - Suffix:
Authorized Official - Credentials:D P M P A
Authorized Official - Phone:727-868-2128
Mailing Address - Street 1:7117 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6708
Mailing Address - Country:US
Mailing Address - Phone:727-868-2128
Mailing Address - Fax:727-868-7491
Practice Address - Street 1:7117 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6708
Practice Address - Country:US
Practice Address - Phone:727-868-2128
Practice Address - Fax:727-868-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1074213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390198000Medicaid
FL87662OtherBCBS
FL3901980002Medicaid
FL480009820OtherMEDICARE RAILROAD
FL87662UOtherMEDICARE PTAN
FL87662OtherBCBS
FL1266080001Medicare NSC