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General NPI Number Information
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NPI Number | 1740774447
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Entity Type | Individual
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Provider Name | CALEB TAGUE MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 4963 W 135TH ST
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City | LEAWOOD
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State | KS
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Zip | 66224-6901
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Country | US
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Telephone | 913-814-8222
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Fax | 800-886-3634
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Provider Business Mailing Address
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Address Line | 4963 W 135TH ST
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City | LEAWOOD
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State | KS
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Zip | 66224-6901
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Country | US
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Telephone | 913-814-8222
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Fax | 800-886-3634
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-44339
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2018020668
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License Number State | MO
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