Healthcare Provider Details

I. General information

NPI: 1316992993
Provider Name (Legal Business Name): BEVERLY A. CALUB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 E WHITETAIL CT
MANITOWOC WI
54220-8302
US

IV. Provider business mailing address

4528 E WHITETAIL CT
MANITOWOC WI
54220-8302
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-7481
  • Fax:
Mailing address:
  • Phone: 773-636-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63539-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: