Healthcare Provider Details

I. General information

NPI: 1205656451
Provider Name (Legal Business Name): REBECCA ELLEN CALANGELO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOPER AVE STE 3100
SAGINAW MI
48602-5182
US

IV. Provider business mailing address

6220 GARFIELD RD
FREELAND MI
48623-8620
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-7450
  • Fax:
Mailing address:
  • Phone: 989-992-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: