Provider Demographics
NPI:1871741132
Name:KALINA, JARED ALLAN (DO)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:ALLAN
Last Name:KALINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1213
Mailing Address - Country:US
Mailing Address - Phone:708-628-8574
Mailing Address - Fax:
Practice Address - Street 1:334 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1610
Practice Address - Country:US
Practice Address - Phone:708-628-8574
Practice Address - Fax:866-282-9069
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119113208VP0014X
CA20A11293207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119113OtherPHYSICIAN LICENSE
CA20A1129 3OtherCALIFORNIA MEDICAL LICENSE