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General NPI Number Information
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NPI Number | 1396304788
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Entity Type | Individual
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Provider Name | KARINA MARIEL CALDERON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 610 S MAPLE AVE STE 3700
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City | OAK PARK
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State | IL
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Zip | 60304-2806
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Country | US
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Telephone | 708-660-6430
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Fax | 708-660-6447
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Provider Business Mailing Address
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Address Line | 909 W BUENA AVE APT 3E
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City | CHICAGO
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State | IL
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Zip | 60613-1693
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Country | US
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Telephone |
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085.007044
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.007044
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License Number State | IL
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