Provider Demographics
NPI:1144597741
Name:CALOBRACE, MICHAEL BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:CALOBRACE
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 1:2341 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3460
Mailing Address - Country:US
Mailing Address - Phone:502-899-9979
Mailing Address - Fax:
Practice Address - Street 1:2341 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3460
Practice Address - Country:US
Practice Address - Phone:502-899-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32666208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery