Healthcare Provider Details

I. General information

NPI: 1952742587
Provider Name (Legal Business Name): ADITYA KALAKONDA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HOUSTON RD
FLORENCE KY
41042-4824
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-6466
  • Fax: 859-344-7930
Mailing address:
  • Phone: 859-331-6466
  • Fax: 859-344-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.146977
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01087498A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number52462
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: