| Doctor Name: | DR. KEITH JAY KALISH |
| NPI Number: | 1023124609 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | PO-001790 |
| Business Practice Address: | 2500 Quincy Ave Fort Pierce, FL - 349474766 |
| Business Phone Number: | 7724653207 |
| Business Fax Number: | 7724653235 |
| Mailing Address: | 2500 Quincy Ave, FORT PIERCE |
| State: | FL |
| Postal Code: | 349474766 |
| Phone Number: | 7724653207 |
| Fax Number: | 7724653235 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | PO-001790 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |