Provider Demographics
NPI:1336280122
Name:CALERO, ELEAZAR E (MD)
Entity Type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:E
Last Name:CALERO
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 1:100 W CHICAGO AVE
Mailing Address - Street 2:STE F
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3261
Mailing Address - Country:US
Mailing Address - Phone:219-703-2583
Mailing Address - Fax:219-703-6749
Practice Address - Street 1:4324 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5012
Practice Address - Country:US
Practice Address - Phone:773-767-3171
Practice Address - Fax:773-767-9227
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110201552OtherPALMETTO
IL1720250129OtherPALMETTO GROUP NPI
IL1720250129OtherPALMETTO GROUP NPI
IL559420Medicare ID - Type Unspecified