Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1062 | MN |
N | 213ES0103X | Foot & Ankle Surgery | 1062 | MN |
NPI | 1558898114 |
---|---|
Provider Name | Kristofor James Kalvig |
First Address | Tulsa, OK 74133-4598 |
Second Address | Tulsa, OK 74135-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 23/09/2021 |