Provider Demographics
NPI:1750520458
Name:M KALAKOTA MD PA
Entity type:Organization
Organization Name:M KALAKOTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHUSUDANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KALAKOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-931-2991
Mailing Address - Street 1:1920 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2331
Mailing Address - Country:US
Mailing Address - Phone:407-931-2991
Mailing Address - Fax:407-933-4699
Practice Address - Street 1:1920 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2331
Practice Address - Country:US
Practice Address - Phone:407-931-2991
Practice Address - Fax:407-933-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061078302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17758Medicare UPIN
FL17758ZMedicare PIN