Healthcare Provider Details

I. General information

NPI: 1316454499
Provider Name (Legal Business Name): LAXMAN KALVAKUNTLA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S MASON RD STE A4
KATY TX
77450-3863
US

IV. Provider business mailing address

830 S MASON RD STE A4
KATY TX
77450-3863
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-8010
  • Fax: 281-392-4861
Mailing address:
  • Phone: 281-392-8010
  • Fax: 281-392-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ2627
License Number StateTX

VIII. Authorized Official

Name: MR. LAXMAN KALVAKUNTLA
Title or Position: OWNER
Credential: MD
Phone: 281-392-8010