Healthcare Provider Details

I. General information

NPI: 1730153529
Provider Name (Legal Business Name): ELLISON F. KALDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH BRUCE STREET AFFILIATED COMMUNITY MEDICAL CENTERS
MARSHALL MN
56258
US

IV. Provider business mailing address

300 SOUTH BRUCE STREET AFFILIATED COMMUNITY MEDICAL CENTERS
MARSHALL MN
56258
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-9631
  • Fax: 507-532-1176
Mailing address:
  • Phone: 507-532-9631
  • Fax: 507-532-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1227
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: