Provider Demographics
NPI:1225259385
Name:KAMALOV, GERMAN G (MD)
Entity Type:Individual
Prefix:
First Name:GERMAN
Middle Name:G
Last Name:KAMALOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 DODSON AVE
Mailing Address - Street 2:SUITE 60
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5182
Mailing Address - Country:US
Mailing Address - Phone:479-709-7325
Mailing Address - Fax:479-709-7335
Practice Address - Street 1:5514 CORPORATE DR STE 150
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7763
Practice Address - Country:US
Practice Address - Phone:816-271-1265
Practice Address - Fax:816-271-4060
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN44869207R00000X
OH35.099425207RC0000X
ARE-8764207RC0000X, 207RC0001X
MO2020017657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200607530AMedicaid
AR186470001Medicaid
AR390680YH5HMedicare PIN