Provider Demographics
NPI:1639378979
Name:APOSTOLOS E KALOVIDOURIS MD
Entity Type:Organization
Organization Name:APOSTOLOS E KALOVIDOURIS MD
Other - Org Name:SOUTHERN INDIANA RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:APOSTOLOS
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:KALOVIDOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-348-4080
Mailing Address - Street 1:2109 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2224
Mailing Address - Country:US
Mailing Address - Phone:812-348-4080
Mailing Address - Fax:812-348-4090
Practice Address - Street 1:2109 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2224
Practice Address - Country:US
Practice Address - Phone:812-348-4080
Practice Address - Fax:812-348-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028509A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200335450AMedicaid