MEDICARE: KENNETH M CALDWELL 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	207X00000X	Orthopaedic Surgery Physician	A22558	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A225581	OTHER	CA	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457398224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH M CALDWELL MD

Provider Business Mailing Address
First Line	:	PO BOX 1298
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-1298
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

Provider Business Practice Location Address
First Line	:	3717 MT DIABLO BLVD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3547
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/16/2018

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