Provider Demographics
NPI:1982762712
Name:KALEEM, MOHAMMED (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:KALEEM
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6806
Mailing Address - Country:US
Mailing Address - Phone:386-326-3633
Mailing Address - Fax:386-312-5080
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6806
Practice Address - Country:US
Practice Address - Phone:386-326-3633
Practice Address - Fax:386-312-5080
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 78625207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47147OtherBLUE CROSS BLUE SHIELD
FL47147Medicare PIN
FLG88921Medicare UPIN