Provider Demographics
NPI:1902979453
Name:PERRY KALIS M.D. INC
Entity Type:Organization
Organization Name:PERRY KALIS M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-588-0008
Mailing Address - Street 1:129 NORTH MAYSVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7507
Mailing Address - Country:US
Mailing Address - Phone:740-588-0008
Mailing Address - Fax:740-588-0143
Practice Address - Street 1:129 NORTH MAYSVILLE AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-588-0008
Practice Address - Fax:740-588-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038121K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH210780OtherNATIONWIDE INSURANCE
OH0404062OtherUNITED HEALTHCARE
OH235727435003OtherMEDICAL MUTUAL
OH000000122256OtherANTHEM INDIVIDUAL
OH000000162736OtherANTHEM-GROUP
OH2056028Medicaid
OH000000217078OtherANTHEM-LAB
OH6952646002OtherCIGNA
OH23572743500OtherBWC
OHM38121AOtherHEALTH PLAN
OH2056028Medicaid
OH6952646002OtherCIGNA
OHM38121AOtherHEALTH PLAN
OH6952646002OtherCIGNA
OH=========00OtherCENTRAL BENEFITS- PREFERR
OH000000217078OtherANTHEM-LAB