Provider Demographics
NPI:1316454499
Name:LAXMAN KALVAKUNTLA MD PLLC
Entity type:Organization
Organization Name:LAXMAN KALVAKUNTLA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAXMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALVAKUNTLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-392-8010
Mailing Address - Street 1:830 S MASON RD STE A4
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3863
Mailing Address - Country:US
Mailing Address - Phone:281-392-8010
Mailing Address - Fax:281-392-4861
Practice Address - Street 1:830 S MASON RD STE A4
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3863
Practice Address - Country:US
Practice Address - Phone:281-392-8010
Practice Address - Fax:281-392-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013913623OtherSOLO NPI