Healthcare Provider Details

I. General information

NPI: 1457433831
Provider Name (Legal Business Name): SHARAT C KALVAKOTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MIAMISBURG CENTERVILLE RD STE 450
MIAMISBURG OH
45342-3908
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-560-2011
  • Fax: 937-562-2012
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35045600
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-04-5600
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: