Provider Demographics
NPI:1558716894
Name:CALLEWAERT, KEITH EDWARD (RN)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWARD
Last Name:CALLEWAERT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48301 TONAWONDA DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5575
Mailing Address - Country:US
Mailing Address - Phone:586-524-6757
Mailing Address - Fax:
Practice Address - Street 1:48301 TONAWONDA DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-524-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3201011305146L00000X
MI4704273227367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic