Healthcare Provider Details

I. General information

NPI: 1134616220
Provider Name (Legal Business Name): KALPANA GORTHI, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 CLASSIC CT STE 102
MELBOURNE FL
32940-8279
US

IV. Provider business mailing address

3155 SUNTREE BLVD STE 102
ROCKLEDGE FL
32955-5720
US

V. Phone/Fax

Practice location:
  • Phone: 321-425-3187
  • Fax: 321-425-3188
Mailing address:
  • Phone: 321-425-3187
  • Fax: 321-425-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KALPANA GORTHI
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 931-575-7833