Provider Demographics
NPI:1689751398
Name:KALANTA, WILLIAM J (DPM)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:KALANTA
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 1:1941 MITCHELL RD
Mailing Address - Street 2:STE-R
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2434
Mailing Address - Country:US
Mailing Address - Phone:209-538-1731
Mailing Address - Fax:209-581-0540
Practice Address - Street 1:1941 MITCHELL RD
Practice Address - Street 2:STE-R
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2434
Practice Address - Country:US
Practice Address - Phone:209-538-1731
Practice Address - Fax:209-581-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2136213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE21361Medicaid
CAT11194Medicare UPIN
CAE21361Medicare ID - Type UnspecifiedMEDICARE
CAE21361Medicaid