Provider Demographics
NPI:1730214206
Name:GAVINI, KALYANI (MD)
Entity type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:
Last Name:GAVINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2328
Mailing Address - Country:US
Mailing Address - Phone:618-332-2083
Mailing Address - Fax:618-337-6039
Practice Address - Street 1:6000 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2328
Practice Address - Country:US
Practice Address - Phone:618-332-2083
Practice Address - Fax:618-337-6039
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140235722084P0804X, 2084P0804X
IL0361195232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry