MEDICARE: ELEAZAR E CALERO 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	036078184	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110201552	OTHER	IL	PALMETTO
2	1720250129	OTHER	IL	PALMETTO GROUP NPI

General Provider Information

NPI Number	:	1336280122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEAZAR E CALERO MD

Provider Business Mailing Address
First Line	:	100 W CHICAGO AVE
Second Line	:	STE F
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3261
Country	:	US
Telephone Number	:	219-703-2583
Fax Number	:	219-703-6749

Provider Business Practice Location Address
First Line	:	4324 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5012
Country	:	US
Telephone Number	:	773-767-3171
Fax Number	:	773-767-9227

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/13/2019

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