Healthcare Provider Details

I. General information

NPI: 1316146236
Provider Name (Legal Business Name): NISHANT KALRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 200
GRAND RAPIDS MI
49546-3691
US

IV. Provider business mailing address

PO BOX 2119
ELIZABETHTOWN KY
42702-2119
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3450
  • Fax:
Mailing address:
  • Phone: 270-765-5921
  • Fax: 270-506-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301083175
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number42578
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37199
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number42578
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.125165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: