Healthcare Provider Details

I. General information

NPI: 1639733678
Provider Name (Legal Business Name): CALE CHARLES STREETER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 N HOLLAND SYLVANIA RD STE B
SYLVANIA OH
43560-2149
US

IV. Provider business mailing address

4805 FAIRWAY LN
SYLVANIA OH
43560-2225
US

V. Phone/Fax

Practice location:
  • Phone: 419-537-0900
  • Fax: 419-537-1300
Mailing address:
  • Phone: 734-276-2253
  • Fax: 419-537-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.148510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: