Individual
DR. MADHU T KALYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 W MAPLE AVE STE 101, SPRINGDALE, AR 72764-5370
(479) 757-4720
(479) 757-2995
Mailing address
601 W MAPLE AVE, SUITE 704, SPRINGDALE, AR 72764-5335
(479) 757-3717
(479) 856-5307
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
E3298
AR
207RP1001X
Pulmonary Disease Physician
Primary
E-3298
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146947001
—
AR
05
—
200008290A
—
OK
01
—
5H893
MEDICARE PTAN
AR
01
—
P00196415
RR MCR
AR
Enumeration date
06/19/2006
Last updated
09/09/2020
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