Healthcare Provider Details

I. General information

NPI: 1942294343
Provider Name (Legal Business Name): AJAY KALRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13731 METROPOLIS AVE
FORT MYERS FL
33912-7150
US

IV. Provider business mailing address

13731 METROPOLIS AVE
FORT MYERS FL
33912-7150
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-8555
  • Fax: 239-936-5611
Mailing address:
  • Phone: 239-936-8555
  • Fax: 239-936-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME85408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME85409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: