Provider Demographics
NPI:1679780969
Name:AKKINENI, KALYAN (MD)
Entity type:Individual
Prefix:
First Name:KALYAN
Middle Name:
Last Name:AKKINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 CALLAWAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8437
Mailing Address - Country:US
Mailing Address - Phone:423-426-3918
Mailing Address - Fax:479-757-2977
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:423-426-3918
Practice Address - Fax:479-757-2977
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5691207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200201000AMedicaid
AR172952001Medicaid
OK200201000AMedicaid