Basic Information
Provider Information
NPI: 1861459612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KALAFAT
FirstName: NACIYE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22040
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543052040
CountryCode: US
TelephoneNumber: 9204457222
FaxNumber: 9204457289
Practice Location
Address1: 301 E SAINT JOSEPH ST
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543012241
CountryCode: US
TelephoneNumber: 9204336073
FaxNumber: 9204310333
Other Information
ProviderEnumerationDate: 04/26/2006
LastUpdateDate: 11/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X60818-20WIY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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