Healthcare Provider Details

I. General information

NPI: 1003018250
Provider Name (Legal Business Name): DOMENICO CALCATERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD STE 3300
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

5304 4TH AVENUE CIR E
BRADENTON FL
34208-5624
US

V. Phone/Fax

Practice location:
  • Phone: 317-923-1787
  • Fax: 317-962-6259
Mailing address:
  • Phone: 941-744-2640
  • Fax: 941-744-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME97069
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number38062
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01071025A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: