MEDICARE: COLETTE SUZANNE CALAME CCP LP

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	242T00000X	Perfusionist	6	OK

General Provider Information

NPI Number	:	1386921864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLETTE SUZANNE CALAME CCP LP

Provider Business Mailing Address
First Line	:	6124 PANDA WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-8410
Country	:	US
Telephone Number	:	405-620-2412
Fax Number	:	405-271-6135

Provider Business Practice Location Address
First Line	:	6124 PANDA WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-8410
Country	:	US
Telephone Number	:	405-620-2412
Fax Number	:	405-271-6135

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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