Healthcare Provider Details

I. General information

NPI: 1477707610
Provider Name (Legal Business Name): MICHAEL V CALVIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 SIGNAL AVE NE
ALBUQUERQUE NM
87113-2453
US

IV. Provider business mailing address

DEPT. 453 PO BOX 1000
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-2735
  • Fax: 505-856-2749
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2020-0074
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: