Provider Demographics
NPI:1417163809
Name:JEFFERSON N CALIMLIM MD SC
Entity Type:Organization
Organization Name:JEFFERSON N CALIMLIM MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CALIMLIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-384-3838
Mailing Address - Street 1:1550 E. ROYALL PLACE
Mailing Address - Street 2:#1002
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-384-3838
Mailing Address - Fax:
Practice Address - Street 1:1550 E. ROYALL PLACE
Practice Address - Street 2:#1002
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202
Practice Address - Country:US
Practice Address - Phone:414-384-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30256300Medicaid
WI30256300Medicaid