MEDICARE: JEFFERSON N CALIMLIM MD SC

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	174400000X	Specialist		WI

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

General Provider Information

NPI Number	:	1417163809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON N CALIMLIM MD SC

Provider Business Mailing Address
First Line	:	1550 E. ROYALL PLACE
Second Line	:	#1002
City	:	MILWAUKEE
State	:	WI
Zip	:	53202
Country	:	US
Telephone Number	:	414-384-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E. ROYALL PLACE
Second Line	:	#1002
City	:	MILWAUKEE
State	:	WI
Zip	:	53202
Country	:	US
Telephone Number	:	414-384-3838
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, PHYSICIAN
Name	:	DR. JEFFERSON CALIMLIM
Credential	:
Telephone Number	:	414-384-3838

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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