Provider Demographics
NPI:1346216256
Name:KALINKA, PETER JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:KALINKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1901
Mailing Address - Country:US
Mailing Address - Phone:262-654-7991
Mailing Address - Fax:262-654-8331
Practice Address - Street 1:3725 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1901
Practice Address - Country:US
Practice Address - Phone:262-654-7991
Practice Address - Fax:262-654-8331
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2306-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38578100Medicaid
WIP00637569Medicare PIN
WI47900Medicare ID - Type Unspecified
WIU32175Medicare UPIN