Provider Demographics
NPI:1689643017
Name:KALWANI, RITU M (MD)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:M
Last Name:KALWANI
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2479
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7624
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035180A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397198OtherPHCS PID NUMBER
INKA64890011Medicaid
IN000000197893OtherANTHEM PROVIDER NUMBER
IN100206600Medicaid
IN10825352OtherCAQH NUMBER
IN110165916Medicare PIN
INE03836Medicare UPIN
INKA64890011Medicaid