Provider Demographics
NPI:1396741336
Name:KALOVIDOURIS, CLARITA L (MD)
Entity type:Individual
Prefix:DR
First Name:CLARITA
Middle Name:L
Last Name:KALOVIDOURIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2224
Mailing Address - Country:US
Mailing Address - Phone:812-348-4080
Mailing Address - Fax:812-348-4090
Practice Address - Street 1:2109 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2224
Practice Address - Country:US
Practice Address - Phone:812-348-4080
Practice Address - Fax:812-348-4090
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028437A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000180287OtherANTHEM BLUE CROSS
IN002413OtherSIHO
IN150510Medicare ID - Type Unspecified
IN000000180287OtherANTHEM BLUE CROSS