Provider Demographics
NPI:1902822539
Name:ARULSELVAM, KALEESWARI (MD)
Entity Type:Individual
Prefix:
First Name:KALEESWARI
Middle Name:
Last Name:ARULSELVAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALEESWARI
Other - Middle Name:
Other - Last Name:RAMANAMURTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 S.MARION AVENUE
Mailing Address - Street 2:VETERANS HEALTH SYSTEM
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-719-3622
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-719-3622
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276003700Medicaid
U8048ZMedicare PIN
I60191Medicare UPIN