Provider Demographics
NPI:1497161285
Name:CALDERON, EMANUEL (PT)
Entity Type:Individual
Prefix:MR
First Name:EMANUEL
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E MICHIGAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2840
Mailing Address - Country:US
Mailing Address - Phone:517-253-8360
Mailing Address - Fax:
Practice Address - Street 1:1717 E MICHIGAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2840
Practice Address - Country:US
Practice Address - Phone:517-253-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-02-13
Deactivation Date:2015-05-19
Deactivation Code:
Reactivation Date:2020-02-13
Provider Licenses
StateLicense IDTaxonomies
MI5501009083208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation