Provider Demographics
NPI:1083690713
Name:CALESTINO, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CALESTINO
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 1:985 STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5664
Mailing Address - Country:US
Mailing Address - Phone:407-831-5252
Mailing Address - Fax:407-831-3765
Practice Address - Street 1:985 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078873207R00000X, 208M00000X
FLME118584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00385012Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MIP28070142Medicare PIN
MI70-0-F32947-0OtherBCBS CPIN #