Healthcare Provider Details

I. General information

NPI: 1114432093
Provider Name (Legal Business Name): RAJAT KALRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN STREET WT-19345H
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

6621 FANNIN STREET WT-19345H
HOUSTON TX
77030-2399
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-1929
  • Fax: 832-825-1904
Mailing address:
  • Phone: 832-826-1929
  • Fax: 832-825-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number45940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: