Provider Demographics
NPI:1427001668
Name:KALLENBERGER, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KALLENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4445
Mailing Address - Country:US
Mailing Address - Phone:405-945-4701
Mailing Address - Fax:405-945-4728
Practice Address - Street 1:3433 NW 56TH ST STE 210B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4445
Practice Address - Country:US
Practice Address - Phone:405-945-4701
Practice Address - Fax:405-945-4728
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1235398397OtherGROUP NPI
OK1235398397OtherGROUP NPI