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General NPI Number Information
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NPI Number | 1851513436
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Entity Type | Individual
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Provider Name | CALLEY A. LIDLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 233 GRAND AVENUE
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City | ST. PAUL
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State | MN
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Zip | 55102-9658
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Country | US
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Telephone | 651-227-7806
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Fax | 651-256-6707
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Provider Business Mailing Address
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Address Line | 233 GRAND AVENUE
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City | ST. PAUL
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State | MN
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Zip | 55102-9658
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Country | US
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Telephone | 651-227-7806
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Fax | 651-256-6707
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125050402
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 51175
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 52074-020
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License Number State | WI
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