MEDICARE: DR. JAGADEESH KUMAR KALAVAKUNTA M.D.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301091982	MI
2	207RI0011X	Interventional Cardiology Physician	4301091982	MI
3	207RC0000X	Cardiovascular Disease Physician	4301091982	MI

General Provider Information

NPI Number	:	1457510505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAGADEESH KUMAR KALAVAKUNTA M.D.,

Provider Business Mailing Address
First Line	:	5943 STADIUM DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-3016
Country	:	US
Telephone Number	:	269-552-2836
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 E CHICAGO ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2074
Country	:	US
Telephone Number	:	269-226-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/15/2015

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