Provider Demographics
NPI:1407039860
Name:KALAKATA, VIJAYASEKHARA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYASEKHARA
Middle Name:REDDY
Last Name:KALAKATA
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 1:208 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4061
Mailing Address - Country:US
Mailing Address - Phone:352-365-0045
Mailing Address - Fax:353-364-0047
Practice Address - Street 1:690 NE 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3541
Practice Address - Country:US
Practice Address - Phone:352-365-0045
Practice Address - Fax:353-364-0047
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045574208100000X
FLME101929208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation