Provider Demographics
NPI:1134616220
Name:KALPANA GORTHI, MD, PLLC
Entity type:Organization
Organization Name:KALPANA GORTHI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-575-7833
Mailing Address - Street 1:3155 SUNTREE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5720
Mailing Address - Country:US
Mailing Address - Phone:321-425-3187
Mailing Address - Fax:321-425-3188
Practice Address - Street 1:3155 SUNTREE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5720
Practice Address - Country:US
Practice Address - Phone:321-425-3187
Practice Address - Fax:321-425-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty