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General NPI Number Information
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NPI Number | 1336280122
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Entity Type | Individual
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Provider Name | ELEAZAR E CALERO MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 4324 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-5012
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Country | US
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Telephone | 773-767-3171
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Fax | 773-767-9227
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Provider Business Mailing Address
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Address Line | 100 W CHICAGO AVE STE F
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3261
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Country | US
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Telephone | 219-703-2583
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Fax | 219-703-6749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036078184
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License Number State | IL
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