Provider Demographics
NPI: | 1407835234 |
---|---|
Name: | KALEMERIS, GEORGE C (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | GEORGE |
Middle Name: | C |
Last Name: | KALEMERIS |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7111 FAIRWAY DR |
Mailing Address - Street 2: | SUITE 400 |
Mailing Address - City: | PALM BEACH GARDENS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33418-4204 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-712-6265 |
Mailing Address - Fax: | 561-712-7349 |
Practice Address - Street 1: | 1620 MEDICAL LN |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | FT MYERS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33907-1143 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-275-1164 |
Practice Address - Fax: | 239-275-5212 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-11 |
Last Update Date: | 2014-07-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME0047590 | 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 042149900 | Medicaid | |
FL | P109404 | Other | FREEDOM HEALTH |
FL | P929616 | Other | OPTIMUM |
FL | 042149900 | Medicaid | |
FL | P929616 | Other | OPTIMUM |