MEDICARE: DR. ESLY CALDWELL II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35042906C	OH
2	207R00000X	Internal Medicine Physician	23202	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306944673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESLY CALDWELL II MD

Provider Business Mailing Address
First Line	:	2215 UPLAND PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2212
Country	:	US
Telephone Number	:	513-861-1354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 UPLAND PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2212
Country	:	US
Telephone Number	:	513-861-1354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/10/2009

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