Basic Information
| Provider Information | |||||||||
| NPI: | 1508808361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALFAS | ||||||||
| FirstName: | MINA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597570717 | ||||||||
| FaxNumber: | 8593312425 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 CENTRE VIEW BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597570717 | ||||||||
| FaxNumber: | 8593312425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 31945 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | 31945 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64319452 | 05 | KY | MEDICAID | 0987357 | 05 | OH | MEDICAID |