Provider Demographics
NPI:1215056817
Name:KALU, OLIVIA (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:KALU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:UZOMA
Other - Middle Name:M
Other - Last Name:KALU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 36258
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1204
Mailing Address - Country:US
Mailing Address - Phone:251-318-2678
Mailing Address - Fax:251-405-9900
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3580
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0003225207R00000X
IN01065819A208M00000X
AL49590208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000640362OtherANTHEM PROVIDER NUMBER
IN200973010Medicaid
IN815500CC5Medicare PIN
IN000000640362OtherANTHEM PROVIDER NUMBER