Provider Demographics
NPI:1649578238
Name:REYNALDO M. CALUAG MD SC
Entity Type:Organization
Organization Name:REYNALDO M. CALUAG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CALUAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-345-2140
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-345-2140
Mailing Address - Fax:708-345-2141
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 411
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-345-2140
Practice Address - Fax:708-345-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096640Medicaid
IL1255477857OtherNPI
ILG38781Medicare UPIN