Provider Demographics
NPI:1558898114
Name:KALVIG, KRISTOFOR JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:KRISTOFOR
Middle Name:JAMES
Last Name:KALVIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 E 47TH PL STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2911
Mailing Address - Country:US
Mailing Address - Phone:918-951-0968
Mailing Address - Fax:
Practice Address - Street 1:3315 E 47TH PL STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2911
Practice Address - Country:US
Practice Address - Phone:918-951-0968
Practice Address - Fax:918-749-2350
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1062213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty