Basic Information
| Provider Information | |||||||||
| NPI: | 1497976526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLA | ||||||||
| FirstName: | SHRISH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KALLA | ||||||||
| OtherFirstName: | SHRISH | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1565 SAXON BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869177395 | ||||||||
| FaxNumber: | 3865327152 | ||||||||
| Practice Location | |||||||||
| Address1: | 1565 SAXON BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869177395 | ||||||||
| FaxNumber: | 3865327152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 01/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME96049 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.