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NPI Code Detail

MEDICARE: DR. CYNTHIA ECLAVEA KALLET DO

MEDICARE: DR. CYNTHIA ECLAVEA KALLET DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5915OH

General Provider Information

NPI Number : 1205836533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYNTHIA ECLAVEA KALLET DO
Provider Business Mailing Address
First Line : 3328 S SMITHVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45420-1500
Country : US
Telephone Number : 937-254-5661
Fax Number : 937-254-7367
Provider Business Practice Location Address
First Line : 3328 S SMITHVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45420-1500
Country : US
Telephone Number : 937-254-5661
Fax Number : 937-254-7367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 02/18/2010

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