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1609209949

NPI Code Detail

MEDICARE: DEEPTI KALLAM MD

MEDICARE: DEEPTI KALLAM MD

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
1	207RX0202X	Medical Oncology Physician	S1620	TX
2	207RH0003X	Hematology & Oncology Physician	S1620	TX
3	207RX0202X	Medical Oncology Physician	35C00445	OH
4	207RH0003X	Hematology & Oncology Physician	35C000445	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609209949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPTI KALLAM MD

Provider Business Mailing Address
First Line	:	3107 W CAMP WISDOM RD STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2600
Country	:	US
Telephone Number	:	214-765-2222
Fax Number	:	214-269-9902

Provider Business Practice Location Address
First Line	:	3107 W CAMP WISDOM RD STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2600
Country	:	US
Telephone Number	:	214-765-2222
Fax Number	:	214-269-9902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	07/23/2024

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Directions to “ DEEPTI KALLAM MD” Practice Location

Language	Start Address	Practice Location

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