Provider Demographics
NPI:1639114721
Name:SESHADRI, KALA (MD)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:SESHADRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5172
Mailing Address - Country:US
Mailing Address - Phone:941-627-5151
Mailing Address - Fax:941-629-2036
Practice Address - Street 1:2841 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5172
Practice Address - Country:US
Practice Address - Phone:941-627-5151
Practice Address - Fax:941-629-2036
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79870OtherBC/BS
FL79870YOtherPROVIDER TRANSACTION ACCESS NUMBER
FL79870Medicare ID - Type Unspecified
FL79870OtherBC/BS