Provider Demographics
NPI:1720084619
Name:KALES, LAWRENCE J (DPM)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:J
Last Name:KALES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1074213E00000X
FLPO1074213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390198000Medicaid
FL87662UMedicare PIN
FLT55493Medicare UPIN
87662Medicare PIN
FL1266080001Medicare NSC