Healthcare Provider Details

I. General information

NPI: 1386689644
Provider Name (Legal Business Name): MADHU T KALYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE AVE STE 101
SPRINGDALE AR
72764-5370
US

IV. Provider business mailing address

601 W MAPLE AVE SUITE 704
SPRINGDALE AR
72764-5335
US

V. Phone/Fax

Practice location:
  • Phone: 479-757-4720
  • Fax: 479-757-2995
Mailing address:
  • Phone: 479-757-3717
  • Fax: 479-856-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE3298
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-3298
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: