Provider Demographics
NPI:1477707610
Name:CALVIN, MICHAEL V (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:CALVIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:7001 SIGNAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2453
Practice Address - Country:US
Practice Address - Phone:505-856-2735
Practice Address - Fax:505-856-2749
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2020-0074363A00000X, 363A00000X
CO532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03621243Medicaid
NM1G9384OtherMEDICARE PTAN
NM1G9388OtherMEDICARE PTAN
COCO303124Medicare UPIN
TXTXB149286Medicare PIN