Provider Demographics
NPI:1326590704
Name:KALPHAT-LOSEGO, ELIAS (BS)
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:
Last Name:KALPHAT-LOSEGO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 PALMETTO PINE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4818
Mailing Address - Country:US
Mailing Address - Phone:954-849-0548
Mailing Address - Fax:
Practice Address - Street 1:2005 PALMETTO PINE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4818
Practice Address - Country:US
Practice Address - Phone:954-849-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator