Provider Demographics
NPI:1437727641
Name:MIGDA, CALEB E
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:E
Last Name:MIGDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-2085
Mailing Address - Country:US
Mailing Address - Phone:231-838-0112
Mailing Address - Fax:
Practice Address - Street 1:9055 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-2085
Practice Address - Country:US
Practice Address - Phone:231-838-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321024163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse