Healthcare Provider Details

I. General information

NPI: 1689256141
Provider Name (Legal Business Name): NICHOLAS JERRY CALVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 72ND ST STE 502
SOUTH MIAMI FL
33143-4830
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-9777
  • Fax: 786-533-9450
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME181449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: