Healthcare Provider Details

I. General information

NPI: 1174685515
Provider Name (Legal Business Name): RAVISHANKAR V KALAGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

PO BOX 1210
WATERTOWN SD
57201-6210
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7000
  • Fax: 605-882-7607
Mailing address:
  • Phone: 605-882-7000
  • Fax: 605-882-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22045
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number22045
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE-9510
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number9527
License Number StateSD
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number9527
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: