Provider Demographics
NPI:1285608521
Name:KALICINSKY, IHOR B (MD)
Entity type:Individual
Prefix:DR
First Name:IHOR
Middle Name:B
Last Name:KALICINSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4962
Mailing Address - Country:US
Mailing Address - Phone:559-732-4801
Mailing Address - Fax:559-732-4524
Practice Address - Street 1:1630 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4962
Practice Address - Country:US
Practice Address - Phone:559-732-4801
Practice Address - Fax:559-732-4524
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C432890Medicaid
CAC043289OtherST OF CA
BK4526868OtherDEA
CA00C432890Medicaid
CA00C432890Medicare PIN