Healthcare Provider Details

I. General information

NPI: 1083064968
Provider Name (Legal Business Name): JEREMY KALMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD STE 101
LEXINGTON KY
40503-1410
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD STE 101
LEXINGTON KY
40503-1410
US

V. Phone/Fax

Practice location:
  • Phone: 859-899-7950
  • Fax: 859-260-5150
Mailing address:
  • Phone: 859-899-7950
  • Fax: 859-260-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number56762
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301117434
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberDR.0065760
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number56762
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: