Provider Demographics
NPI:1114011798
Name:KALMBACH, THOMAS K (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:KALMBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:219-755-0748
Practice Address - Street 1:8687 CONNECTICUT
Practice Address - Street 2:SUITE F
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-769-7800
Practice Address - Fax:219-755-0748
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010-41482208G00000X
IN01041482A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001014260OtherANTHEM PROVIDER ID
IN100346780Medicaid
000001014260OtherANTHEM PROVIDER ID
815500150Medicare PIN
D88848Medicare UPIN