Provider Demographics
NPI:1801041041
Name:KALRA, VIKAS KUMAR (MBBS)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:KUMAR
Last Name:KALRA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4581
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4581
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:866-819-6115
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117175207R00000X
AZ49285207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ926394Medicaid
CAZZZ18851ZOtherGRP PTAN NUMBER
AZZ178301Medicare PIN