Healthcare Provider Details

I. General information

NPI: 1255585865
Provider Name (Legal Business Name): ANTONY KALLUR ANTONY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTONY ANTONY KALLUR MD

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 505-724-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2010-0612
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD2010-0612
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberP67172
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberS6565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: