Basic Information
| Provider Information | |||||||||
| NPI: | 1528324068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KADALI | ||||||||
| FirstName: | RENUKA ANANTH KALYAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ACADEMY ST S | ||||||||
| Address2: | SUITE B-8 | ||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279103248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 ACADEMY ST S | ||||||||
| Address2: | SUITE B-8 | ||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279103248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093708 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2015-01645 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.