Healthcare Provider Details

I. General information

NPI: 1225569130
Provider Name (Legal Business Name): KALYAN RAGHAVENDRA CHITTURI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

106 W ARBOR CAMP CIR
SPRING TX
77389-5323
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax: 813-661-6334
Mailing address:
  • Phone: 740-877-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberV7846
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number77846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: