Provider Demographics
NPI:1881636066
Name:A. PAUL KALANITHI MD, PC
Entity type:Organization
Organization Name:A. PAUL KALANITHI MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KALANITHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-757-4359
Mailing Address - Street 1:1753 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3720
Mailing Address - Country:US
Mailing Address - Phone:928-757-4359
Mailing Address - Fax:928-757-2481
Practice Address - Street 1:1753 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3720
Practice Address - Country:US
Practice Address - Phone:928-757-4359
Practice Address - Fax:928-757-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBBHMedicare ID - Type Unspecified