MEDICARE: DR. GLENN MICHAEL CALABRESE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	F3803	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00206855	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8M1656	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1609851625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN MICHAEL CALABRESE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 201606
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-1606
Country	:	US
Telephone Number	:	972-758-3598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 S I-35 E
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6850
Country	:	US
Telephone Number	:	972-758-3598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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