MEDICARE: DR. ALEXANDER KENNETH CALDERONE 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	208000000X	Pediatrics Physician	70967	MN

General Provider Information

NPI Number	:	1578023990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KENNETH CALDERONE MD

Provider Business Mailing Address
First Line	:	14050 NICOLLET AVE STE 300
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5739
Country	:	US
Telephone Number	:	952-435-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	14050 NICOLLET AVE STE 300
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5739
Country	:	US
Telephone Number	:	952-435-2450
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	06/09/2022

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