Provider Demographics
NPI:1942457981
Name:KALAIAH, MUDAPPA KARINERAVANDA (MD)
Entity Type:Individual
Prefix:
First Name:MUDAPPA
Middle Name:KARINERAVANDA
Last Name:KALAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 UNION BLVD
Mailing Address - Street 2:#150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2259
Mailing Address - Country:US
Mailing Address - Phone:303-892-6033
Mailing Address - Fax:303-892-8809
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-359-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43837207RR0500X
CODR.0054308207RR0500X
NE6102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine