Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 010-41482 | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01041482A | IN |
NPI | 1114011798 |
---|---|
Provider Name | Thomas K Kalmbach |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Merrillville, IN 46410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001014260 | ANTHEM PROVIDER ID (01) | |
100346780 | (05) | IN |
D88848 | (02) |