Provider Demographics
NPI:1053532259
Name:COLON & RECTAL CLINIC LLC
Entity type:Organization
Organization Name:COLON & RECTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:KALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-233-9314
Mailing Address - Street 1:PO BOX 6855
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0923
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty