Healthcare Provider Details

I. General information

NPI: 1114011798
Provider Name (Legal Business Name): THOMAS K KALMBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 CONNECTICUT SUITE F
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-7800
  • Fax: 219-755-0748
Mailing address:
  • Phone:
  • Fax: 219-755-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number010-41482
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01041482A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: