Provider Demographics
NPI:1841276029
Name:KALU, VICTOR C (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:C
Last Name:KALU
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 1:26 WINDING HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6436
Mailing Address - Country:US
Mailing Address - Phone:817-988-8345
Mailing Address - Fax:
Practice Address - Street 1:4401 BOOTH CALLOWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7371
Practice Address - Country:US
Practice Address - Phone:817-988-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5226207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX930080795OtherRAILROAD
P00676289OtherMEDICARE RAILROAD
TX8AC240OtherBCBS
TX930080796OtherRAILROAD
TX139838010Medicaid
TX86722JOtherBCBS
TX86940JOtherBCBS
TX89192FOtherBCBS
TX930050846OtherMEDICARE RAILROAD
TX139838004Medicaid
TX139838007Medicaid
TX8F5017Medicare PIN
TX139838010Medicaid