Provider Demographics
NPI:1063852192
Name:CALABRESE, EMILIO CLAUDIO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:CLAUDIO
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 E HIGHWAY 20
Mailing Address - Street 2:SUITE 226
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9755
Mailing Address - Country:US
Mailing Address - Phone:305-934-9988
Mailing Address - Fax:
Practice Address - Street 1:2010 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-460-0052
Practice Address - Fax:844-341-2523
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116123208600000X
COCDR.0000125208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016028200Medicaid